Provider Demographics
NPI:1124319066
Name:MCCANN, JESSE THOMAS (MD PHD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:THOMAS
Last Name:MCCANN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7522 N HIMES AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3205
Mailing Address - Country:US
Mailing Address - Phone:813-931-0500
Mailing Address - Fax:813-935-4055
Practice Address - Street 1:7522 N HIMES AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3205
Practice Address - Country:US
Practice Address - Phone:813-931-0500
Practice Address - Fax:813-935-4055
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270516207WX0107X
FLME132807207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4PPP5OtherFLORIDA BLUE
FL021181600Medicaid