Healthcare Provider Details

I. General information

NPI: 1730201674
Provider Name (Legal Business Name): LOREN E ISAKSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CARILLON PKWY STE 301
SAINT PETERSBURG FL
33716-1115
US

IV. Provider business mailing address

2655 ULMERTON RD # 225
CLEARWATER FL
33762-3337
US

V. Phone/Fax

Practice location:
  • Phone: 727-222-1879
  • Fax: 855-853-7314
Mailing address:
  • Phone: 727-222-1879
  • Fax: 855-853-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number243002
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number066845
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME110222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: