Basic Information
| Provider Information | |||||||||
| NPI: | 1619104486 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JASIN | ||||||||
| FirstName: | HUGO | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 743409 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303743409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275320002 | ||||||||
| FaxNumber: | 7275321325 | ||||||||
| Practice Location | |||||||||
| Address1: | 12780 RACE TRACK RD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336261395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137928878 | ||||||||
| FaxNumber: | 8134438171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2009 | ||||||||
| LastUpdateDate: | 11/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME113748 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 9763896 | 01 | FL | AETNA | OTHER | 007904600 | 05 | FL | MEDICAID | 14NJ5 | 01 | FL | BCBS | OTHER |