Healthcare Provider Details

I. General information

NPI: 1518910280
Provider Name (Legal Business Name): JOHN H NIFFENEGGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 BEE RIDGE RD BLDG D
SARASOTA FL
34233-1207
US

IV. Provider business mailing address

3920 BEE RIDGE RD BLDG D
SARASOTA FL
34233-1207
US

V. Phone/Fax

Practice location:
  • Phone: 941-924-0303
  • Fax:
Mailing address:
  • Phone: 941-924-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME88190
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME88190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: