Individual
JAY JUSTIN OLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4444 E FLETCHER AVE STE D, TAMPA, FL 33613-4905
(813) 971-3846
(813) 977-2611
Mailing address
4444 E FLETCHER AVE STE D, TAMPA, FL 33613-4905
(813) 971-3846
(813) 977-2611
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
ME21356
FL
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
ME21356
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1036672011
CIGNA
FL
01
—
181907220
RAILROAD MEDICARE
FL
01
—
29789
BCBS INDIVIDUAL #
FL
01
—
624179
AETNA
FL
01
—
ME0021356
STATE LICENSE #
FL
Enumeration date
01/09/2006
Last updated
09/07/2018
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