Healthcare Provider Details

I. General information

NPI: 1720151517
Provider Name (Legal Business Name): JOHN M CHOI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 CONROY WINDERMERE RD
ORLANDO FL
32835-2758
US

IV. Provider business mailing address

7425 CONROY WINDERMERE RD
ORLANDO FL
32835-2758
US

V. Phone/Fax

Practice location:
  • Phone: 407-299-7575
  • Fax: 407-299-0957
Mailing address:
  • Phone: 407-299-7575
  • Fax: 407-299-0957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberOS-8298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: