Healthcare Provider Details

I. General information

NPI: 1508802604
Provider Name (Legal Business Name): JOHN G SYMEONIDES M D LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 CYPRESS POINT PKWY UNIT 105
PALM COAST FL
32164-8426
US

IV. Provider business mailing address

PO BOX 354034
PALM COAST FL
32135-4034
US

V. Phone/Fax

Practice location:
  • Phone: 386-246-7596
  • Fax:
Mailing address:
  • Phone: 386-864-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME83577
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN G SYMEONIDES
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 386-864-9800