Provider Demographics
NPI:1912990656
Name:FLORIN, JACK HUGH (MD)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:HUGH
Last Name:FLORIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 LAGUNA RD
Mailing Address - Street 2:STE 208
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3633
Mailing Address - Country:US
Mailing Address - Phone:714-738-0800
Mailing Address - Fax:714-738-3758
Practice Address - Street 1:100 LAGUNA RD
Practice Address - Street 2:STE 208
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3633
Practice Address - Country:US
Practice Address - Phone:714-738-0800
Practice Address - Fax:714-738-3758
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG265612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY48881YMedicaid
A43035Medicare UPIN
CAYYY48881YMedicaid