Healthcare Provider Details

I. General information

NPI: 1518051580
Provider Name (Legal Business Name): JOHN EDWIN MONACO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR C/O BRANDON HOSPITAL
BRANDON FL
33511-5779
US

IV. Provider business mailing address

119 NW 114TH WAY
GAINESVILLE FL
32607-1122
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-7703
  • Fax:
Mailing address:
  • Phone: 352-333-7703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME0040944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: