Provider Demographics
NPI:1215158456
Name:OKUHARA, JASON S (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:OKUHARA
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 KENDA DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-5835
Mailing Address - Country:US
Mailing Address - Phone:727-365-0803
Mailing Address - Fax:941-214-4973
Practice Address - Street 1:10010 KENDA DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5835
Practice Address - Country:US
Practice Address - Phone:727-365-0803
Practice Address - Fax:941-214-4973
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07898300174400000X
MI5101028409207RC0000X
FLOS8993207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001481500Medicaid
FLU4616AMedicare UPIN
FLU4616XMedicare PIN