Healthcare Provider Details

I. General information

NPI: 1215935200
Provider Name (Legal Business Name): JOSEPH SAN JUAN LAYSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13020 FORT KING RD STE 107
DADE CITY FL
33525
US

IV. Provider business mailing address

13020 FORT KING RD STE 107
DADE CITY FL
33525
US

V. Phone/Fax

Practice location:
  • Phone: 352-437-5974
  • Fax: 352-458-4658
Mailing address:
  • Phone: 352-437-5974
  • Fax: 352-458-4658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number223481
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: