Healthcare Provider Details

I. General information

NPI: 1922022854
Provider Name (Legal Business Name): JOHN E ACCOLA JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W OAK ST
KISSIMMEE FL
34741-4924
US

IV. Provider business mailing address

801 W OAK ST SUITE 205
KISSIMMEE FL
34741-6614
US

V. Phone/Fax

Practice location:
  • Phone: 407-518-3703
  • Fax: 407-933-5860
Mailing address:
  • Phone: 407-944-0611
  • Fax: 407-944-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number39260
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number39260
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number39260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: