MEDICARE: DR. JESSE THOMAS MCCANN MD PHD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0107X	Retina Specialist (Ophthalmology) Physician	270516	NY
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	ME132807	FL
3	207W00000X	Ophthalmology Physician	ME132807	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4PPP5	OTHER	FL	FLORIDA BLUE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1124319066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE THOMAS MCCANN MD PHD

Provider Business Mailing Address
First Line	:	7522 N HIMES AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3205
Country	:	US
Telephone Number	:	813-931-0500
Fax Number	:	813-935-4055

Provider Business Practice Location Address
First Line	:	7522 N HIMES AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3205
Country	:	US
Telephone Number	:	813-931-0500
Fax Number	:	813-935-4055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2011
Last Update Date	:	12/12/2025

7524 N HIMES AVE
TAMPA, FL
33614-3205

Practice Phone: 813-931-0500
Practice Fax: