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Individual

MR. POTHEN JACOB

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1840 MEASE DR STE 305, SAFETY HARBOR, FL 34695-6605
(727) 796-4166
(727) 669-5849
Mailing address
3001 EXECUTIVE DR, CLEARWATER, FL 33762-5323
(727) 347-0005
(727) 541-6558

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME55603
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01990
WELLCARE
05
055528200
FL
01
08999
BCBS FLORIDA
01
100013671
RAILROAD MEDICARE
01
1035494
CAREPLUS
01
10694801
CITRUS HEALTHCARE
01
1200283-007
CIGNA
01
206516
AV MED
01
225659
AMERIGROUP
01
2905049
UNITED HEALTHCARE
01
4248344
AETNA
01
9630253
GHI
Enumeration date
01/31/2006
Last updated
10/05/2020
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