MEDICARE: JEFFERY A. PROSSER, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME 81606	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	330394	OTHER	FL	MEDICARE PROVIDER #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366888166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERY A. PROSSER, M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2348
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-2348
Country	:	US
Telephone Number	:	727-940-7664
Fax Number	:	727-940-7710

Provider Business Practice Location Address
First Line	:	905 E MLK DR STE 390
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-4828
Country	:	US
Telephone Number	:	727-940-7664
Fax Number	:	727-940-7710

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFERY ALLEN PROSSER
Credential	:	MD
Telephone Number	:	813-943-1684

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	10/27/2022

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