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General NPI Number Information
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NPI Number | 1174745962
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Entity Type | Individual
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Provider Name | JASON ANDREW BOARDMAN M.D
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 1919 E HWY 50 STE 201
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City | CLERMONT
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State | FL
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Zip | 34711-1975
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Country | US
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Telephone | 352-243-2622
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Fax | 352-243-6277
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Provider Business Mailing Address
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Address Line | 1804 OAKLEY SEAVER DR STE A
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City | CLERMONT
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State | FL
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Zip | 34711-1925
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Country | US
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Telephone | 407-521-3600
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Fax | 407-521-3603
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME92559
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License Number State | FL
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