Healthcare Provider Details

I. General information

NPI: 1780868901
Provider Name (Legal Business Name): JASON JOHN GORSCAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5165 S STATE ROAD 7
LAKE WORTH FL
33449-5456
US

IV. Provider business mailing address

5165 S STATE ROAD 7
LAKE WORTH FL
33449-5456
US

V. Phone/Fax

Practice location:
  • Phone: 561-621-2020
  • Fax: 561-584-5054
Mailing address:
  • Phone: 561-621-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME101320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: