Healthcare Provider Details

I. General information

NPI: 1760483473
Provider Name (Legal Business Name): JEROME H ISAAC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 ARLINGTON ST
SARASOTA FL
34239-3524
US

IV. Provider business mailing address

1880 ARLINGTON ST
SARASOTA FL
34239-3524
US

V. Phone/Fax

Practice location:
  • Phone: 941-365-7362
  • Fax: 941-366-4355
Mailing address:
  • Phone: 941-365-7362
  • Fax: 941-366-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0022387
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number112800
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG26488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: