MEDICARE: DR. JOHN A DESTEFANO D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO 1428	FL

General Provider Information

NPI Number	:	1932225117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A DESTEFANO D.P.M.

Provider Business Mailing Address
First Line	:	212 LOCHMORE RD
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33407-1302
Country	:	US
Telephone Number	:	561-845-0634
Fax Number	:	561-845-0634

Provider Business Practice Location Address
First Line	:	212 LOCHMORE RD
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33407-1302
Country	:	US
Telephone Number	:	561-845-0634
Fax Number	:	561-845-0634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	10/17/2016

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