Healthcare Provider Details

I. General information

NPI: 1528021748
Provider Name (Legal Business Name): JOHN DAVID OKUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W ROBERTSON ST SUITE 102
BRANDON FL
33511-4934
US

IV. Provider business mailing address

721 W ROBERTSON ST SUITE 102
BRANDON FL
33511-4934
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-3707
  • Fax: 813-654-3671
Mailing address:
  • Phone: 813-684-5571
  • Fax: 813-654-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0044550
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: