Healthcare Provider Details

I. General information

NPI: 1255367371
Provider Name (Legal Business Name): JASON L SWERDLOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 US 19 NORTH
PORT RICHEY FL
34668
US

IV. Provider business mailing address

8220 US 19 NORTH
PORT RICHEY FL
34668
US

V. Phone/Fax

Practice location:
  • Phone: 727-841-8505
  • Fax: 727-846-0561
Mailing address:
  • Phone: 727-841-8505
  • Fax: 727-846-0561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME78372
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberME78372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: