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General NPI Number Information
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NPI Number | 1144491630
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Entity Type | Organization
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Legal Business Name | CLERMONT SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 03/20/2008
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Provider Practice Location Address
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Address Line | 1120 CITRUS TOWER BLVD SUITE 127
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City | CLERMONT
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State | FL
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Zip | 34711-1909
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Country | US
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Telephone | 352-536-2351
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Fax | 352-536-2913
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Provider Business Mailing Address
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Address Line | 1120 CITRUS TOWER BLVD SUITE 127
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City | CLERMONT
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State | FL
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Zip | 34711-1909
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Country | US
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Telephone | 352-536-2351
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Fax | 352-536-2913
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON A BOARDMAN
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Credential | M.D.
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Telephone | 352-536-2351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME 92559
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License Number State | FL
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