Provider Demographics
NPI:1174745962
Name:BOARDMAN, JASON ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ANDREW
Last Name:BOARDMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1804 OAKLEY SEAVER DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1925
Mailing Address - Country:US
Mailing Address - Phone:407-521-3600
Mailing Address - Fax:407-521-3603
Practice Address - Street 1:1919 E HWY 50 STE 201
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1975
Practice Address - Country:US
Practice Address - Phone:352-243-2622
Practice Address - Fax:352-243-6277
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME92559208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7460692OtherAETNA PROVIDER NUMBER
FL03417OtherBCBS PROVIDER NUMBER
FL279419500Medicaid
1174745962OtherNPI