Basic Information
| Provider Information | |||||||||
| NPI: | 1346427309 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAIN | ||||||||
| FirstName: | SURBHI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6919 N DALE MABRY HWY STE 250 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336143860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139354210 | ||||||||
| FaxNumber: | 8139327940 | ||||||||
| Practice Location | |||||||||
| Address1: | 6919 N DALE MABRY HWY | ||||||||
| Address2: | STE 210 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336143972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135584900 | ||||||||
| FaxNumber: | 8135582155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2008 | ||||||||
| LastUpdateDate: | 07/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0005X | ME103338 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine | 2083P0011X | ME103338 | FL | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | 207T00000X | ME103338 | FL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 280613400 | 05 | FL | MEDICAID | P01655860 | 01 | FL | RAILROAD MEDICARE | OTHER | 26306 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |