Healthcare Provider Details

I. General information

NPI: 1124319066
Provider Name (Legal Business Name): JESSE THOMAS MCCANN MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7522 N HIMES AVE
TAMPA FL
33614-3205
US

IV. Provider business mailing address

7522 N HIMES AVE
TAMPA FL
33614-3205
US

V. Phone/Fax

Practice location:
  • Phone: 813-931-0500
  • Fax: 813-935-4055
Mailing address:
  • Phone: 813-931-0500
  • Fax: 813-935-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number270516
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME132807
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME132807
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: