Provider Demographics
NPI:1881618411
Name:ZANNIS, JASON M (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:ZANNIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1500 N UNIVERSITY DR
Mailing Address - Street 2:SUITE #112
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8914
Mailing Address - Country:US
Mailing Address - Phone:954-346-3120
Mailing Address - Fax:954-346-5445
Practice Address - Street 1:1500 N UNIVERSITY DR
Practice Address - Street 2:SUITE #112
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8914
Practice Address - Country:US
Practice Address - Phone:954-346-3120
Practice Address - Fax:954-346-5445
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8070207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264476200Medicaid
FL264476200Medicaid
FLE7754XMedicare PIN