Healthcare Provider Details

I. General information

NPI: 1174566103
Provider Name (Legal Business Name): JASON JOHN PIROZZOLO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NORTH ORANGE AVENUE SUITE 600
ORLANDO FL
32801-5202
US

IV. Provider business mailing address

801 NORTH ORANGE AVENUE SUITE 600
ORLANDO FL
32801-5202
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-2100
  • Fax:
Mailing address:
  • Phone: 407-841-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS9821
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS9821
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: