Healthcare Provider Details

I. General information

NPI: 1326063900
Provider Name (Legal Business Name): JOHN B. KAYOMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 N CHARLES RICHARD BEALL BLVD STE 106
DEBARY FL
32713-2211
US

IV. Provider business mailing address

173 N CHARLES RICHARD BEALL BLVD STE 106
DEBARY FL
32713-2211
US

V. Phone/Fax

Practice location:
  • Phone: 386-516-9770
  • Fax: 386-516-9770
Mailing address:
  • Phone: 386-516-9770
  • Fax: 386-516-9770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17503
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: