MEDICARE: DR. JERRY ALAN MARGOLIN M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	17214	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558358382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY ALAN MARGOLIN M.D.

Provider Business Mailing Address
First Line	:	2818 SCOBEE DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-7212
Country	:	US
Telephone Number	:	727-736-4544
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S LINCOLN AVE
Second Line	:	SUITE 26
City	:	CLEARWATER
State	:	FL
Zip	:	33756-5945
Country	:	US
Telephone Number	:	727-442-2193
Fax Number	:	727-466-6483

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/08/2007

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