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General NPI Number Information
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NPI Number | 1407012164
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Entity Type | Individual
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Provider Name | MARIO ANTONIO JOHN MD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 07/30/2022
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Provider Practice Location Address
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Address Line | 3030 HARDEN BLVD
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City | LAKELAND
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State | FL
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Zip | 33803-7952
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Country | US
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Telephone | 863-687-1250
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Fax | 863-687-1258
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Provider Business Mailing Address
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Address Line | 483 N SEMORAN BLVD STE 210
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City | WINTER PARK
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State | FL
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Zip | 32792-3800
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Country | US
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Telephone | 407-500-3627
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Fax | 407-930-4353
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME118804
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License Number State | FL
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