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General NPI Number Information
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NPI Number | 1124294947
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Entity Type | Individual
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Provider Name | ALOYSIUS T BISONG JR. PA
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Gender | Male
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 808 HIGHWAY 466
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City | LADY LAKE
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State | FL
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Zip | 32159
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Country | US
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Telephone | 352-751-0040
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Fax | 352-751-2825
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Provider Business Mailing Address
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Address Line | P O BOZ 850001 DEPT # 8015
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City | ORLANDO
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State | FL
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Zip | 32885-8015
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Country | US
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Telephone | 352-861-0440
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Fax | 352-861-1869
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 9105417
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9105417
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License Number State | FL
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