Healthcare Provider Details

I. General information

NPI: 1548460165
Provider Name (Legal Business Name): JOSEPH ERIC CARDON AA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2007
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 W HIBISCUS BLVD STE215
MELBOURNE FL
32901-2620
US

IV. Provider business mailing address

1775 W HIBISCUS BLVD STE215
MELBOURNE FL
32901-2620
US

V. Phone/Fax

Practice location:
  • Phone: 321-837-3820
  • Fax: 321-837-3654
Mailing address:
  • Phone: 321-837-3820
  • Fax: 321-837-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number005181
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA25
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: