Healthcare Provider Details

I. General information

NPI: 1073575700
Provider Name (Legal Business Name): JON A HARMON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S PARSONS AVE
BRANDON FL
33511-6058
US

IV. Provider business mailing address

PO BOX 862811
ORLANDO FL
32886-2811
US

V. Phone/Fax

Practice location:
  • Phone: 813-654-7771
  • Fax: 913-696-7141
Mailing address:
  • Phone: 800-884-7205
  • Fax: 913-696-7141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JOHN T MASIELLO
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 813-654-7771