Healthcare Provider Details

I. General information

NPI: 1013180561
Provider Name (Legal Business Name): JOHN ASSI, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 W MACCLENNY AVE
MACCLENNY FL
32063-2094
US

IV. Provider business mailing address

3710 GRANDY AVE
JACKSONVILLE FL
32207-6112
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-5766
  • Fax: 904-259-8416
Mailing address:
  • Phone: 904-398-1471
  • Fax: 904-398-1460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMH45615
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN ASSI
Title or Position: OWNER
Credential: MD
Phone: 904-398-1471