Provider Demographics
NPI:1881653269
Name:GERMAIN, DAVID JACOB (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JACOB
Last Name:GERMAIN
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 1:2330 UTAH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4817
Mailing Address - Country:US
Mailing Address - Phone:813-251-5822
Mailing Address - Fax:813-254-4597
Practice Address - Street 1:1 TAMPA GENERAL CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-844-7229
Practice Address - Fax:813-844-7871
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME858552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL118752Medicaid
FL271982700Medicaid
FLU8371WMedicare PIN
FLP00344552Medicare PIN
FLU8371Medicare PIN
FLP00973221Medicare PIN
FLP00350296Medicare PIN
FLU8371UMedicare PIN
AL118752Medicaid
FL271982700Medicaid
FLU8371SMedicare PIN