Healthcare Provider Details

I. General information

NPI: 1679554307
Provider Name (Legal Business Name): JOSE ORLANDO MAYSONET PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 BAYSHORE BLVD
MACDILL AFB FL
33621-1607
US

IV. Provider business mailing address

6419 BRIDGECREST DRIVE
LITHIA FL
33547
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9229
  • Fax: 813-827-9264
Mailing address:
  • Phone: 813-685-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: