Healthcare Provider Details

I. General information

NPI: 1750343679
Provider Name (Legal Business Name): JERRY O CIOCON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S STATE ROAD 7 SUITE 300
PLANTATION FL
33317-3717
US

IV. Provider business mailing address

320 S STATE ROAD 7 SUITE 300
PLANTATION FL
33317-3717
US

V. Phone/Fax

Practice location:
  • Phone: 954-451-3241
  • Fax: 754-206-4332
Mailing address:
  • Phone: 954-451-3241
  • Fax: 754-206-4332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME0054854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: