Provider Demographics
NPI:1134386980
Name:MISRA, SUBHASIS (MD)
Entity type:Individual
Prefix:
First Name:SUBHASIS
Middle Name:
Last Name:MISRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:205 S MOON AVE STE 102A
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5716
Practice Address - Country:US
Practice Address - Phone:813-662-6200
Practice Address - Fax:813-571-1688
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5424208600000X, 2086X0206X
OH35.0921532086X0206X
FLME1335222086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM88522750Medicaid
TX315199501Medicaid
TX315199502Medicaid
OK200480380 AMedicaid
NM88522750Medicaid