MEDICARE: DR. JASON BARRY SUROW MD

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	207Y00000X	Otolaryngology Physician	ME148694	FL

General Provider Information

NPI Number	:	1619968997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON BARRY SUROW MD

Provider Business Mailing Address
First Line	:	8808 RUM RUNNER PL
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34212-2206
Country	:	US
Telephone Number	:	201-739-8684
Fax Number	:

Provider Business Practice Location Address
First Line	:	8808 RUM RUNNER PL
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34212-2206
Country	:	US
Telephone Number	:	201-739-8684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	08/22/2022

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