Healthcare Provider Details

I. General information

NPI: 1124446554
Provider Name (Legal Business Name): JASON RIZZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23471 WALDEN CENTER DR STE 300
ESTERO FL
34134-5016
US

IV. Provider business mailing address

295 SPINDRIFT DR
WILLIAMSVILLE NY
14221-4701
US

V. Phone/Fax

Practice location:
  • Phone: 239-498-3376
  • Fax: 239-498-3379
Mailing address:
  • Phone: 716-831-2600
  • Fax: 716-831-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number296429-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number296429-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: