Provider Demographics
NPI:1063541076
Name:ADLER, JONATHAN ADAM (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ADAM
Last Name:ADLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1509 53RD AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-2866
Mailing Address - Country:US
Mailing Address - Phone:941-753-0220
Mailing Address - Fax:941-753-0279
Practice Address - Street 1:1509 53RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2866
Practice Address - Country:US
Practice Address - Phone:941-753-0220
Practice Address - Fax:941-753-0279
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME58865207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00027436401OtherUNIVERA
FL410049730OtherRAIL ROAD MEDICARE
FL450508003001OtherMEDICAL MUTUAL
FL0548968OtherCIGNA
FL08-10016OtherMEDICA CHOICE
FLV77948OtherAMERIHEALTH
FL98182OtherHEALTHPARTNERS
FL054073100Medicaid
FL11835OtherUNIVERSAL
FL12647OtherBLUE CROSS BLUE SHIELD
FL4271991OtherAETNA
FL9722034OtherGHI
FLN383289OtherSTAYWELL HEALTHEASE WELLC
FL9722034OtherGHI
FL410049730OtherRAIL ROAD MEDICARE