MEDICARE: DR. JASON ALAN WAUGH D.O.

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	207R00000X	Internal Medicine Physician	DR.0054788	CO
2	207R00000X	Internal Medicine Physician	OS18078	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DR.0054788	OTHER	CO	COLORADO STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1629123906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON ALAN WAUGH D.O.

Provider Business Mailing Address
First Line	:	601 S HARBOUR ISLAND BLVD STE 200
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5925
Country	:	US
Telephone Number	:	800-480-5243
Fax Number	:	800-928-7449

Provider Business Practice Location Address
First Line	:	6709 RIDGE RD
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-6834
Country	:	US
Telephone Number	:	727-248-0375
Fax Number	:	844-388-6186

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	11/11/2022

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