Healthcare Provider Details

I. General information

NPI: 1497109847
Provider Name (Legal Business Name): JARED MAX GOPMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3129 ALTERNATE 19
DUNEDIN FL
34698-1503
US

IV. Provider business mailing address

5 E 98TH ST, BOX 1259
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 727-400-4768
  • Fax:
Mailing address:
  • Phone: 212-241-5873
  • Fax: 212-534-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME161008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: