Organization
JACOB K AGAMASU MD PA
Active
Organization
JACOB K AGAMASU MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB K AGAMASU M.D. (OWNER)
(407) 804-9616
Entity
Organization
Contact information
Practice address
731 STIRLING CENTER PL UNIT 1911, LAKE MARY, FL 32746-5209
(407) 804-9616
(407) 804-8331
Mailing address
731 STIRLING CENTER PL UNIT 1911, LAKE MARY, FL 32746-5209
(407) 804-9616
(407) 804-8331
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13045
BCBS
FL
01
—
202573
WELLCARE
FL
Enumeration date
10/23/2006
Last updated
11/20/2024
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