Provider Demographics
NPI:1780868901
Name:GORSCAK, JASON JOHN (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:JOHN
Last Name:GORSCAK
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 1:1035 S STATE ROAD 7 STE 119
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6136
Mailing Address - Country:US
Mailing Address - Phone:561-621-2020
Mailing Address - Fax:
Practice Address - Street 1:1035 S STATE ROAD 7 STE 119
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6136
Practice Address - Country:US
Practice Address - Phone:561-621-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101320207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology