Provider Demographics
NPI:1215341235
Name:RICH, JASON DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DANIEL
Last Name:RICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17325 PAGONIA RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6008
Mailing Address - Country:US
Mailing Address - Phone:407-905-6014
Mailing Address - Fax:407-654-4113
Practice Address - Street 1:17325 PAGONIA RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6008
Practice Address - Country:US
Practice Address - Phone:407-905-6014
Practice Address - Fax:407-654-4113
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133601208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics