Healthcare Provider Details

I. General information

NPI: 1275171589
Provider Name (Legal Business Name): MARIO A JOHN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13900 COUNTY ROAD 455 STE 107-313
CLERMONT FL
34711-9052
US

IV. Provider business mailing address

13900 COUNTY ROAD 455 STE 107-313
CLERMONT FL
34711-9052
US

V. Phone/Fax

Practice location:
  • Phone: 202-257-0428
  • Fax: 407-386-7878
Mailing address:
  • Phone: 202-257-0428
  • Fax: 407-386-7878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIO A JOHN
Title or Position: OWNER
Credential: MD
Phone: 202-257-0428