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General NPI Number Information
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NPI Number | 1801848478
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Entity Type | Individual
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Provider Name | JUAN C BAYOLO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 309 W 1ST ST
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City | SANFORD
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State | FL
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Zip | 32771-1205
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Country | US
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Telephone | 407-324-5035
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Fax |
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Provider Business Mailing Address
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Address Line | 3131 EGRETS LANDING DR
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City | LAKE MARY
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State | FL
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Zip | 32746-7419
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Country | US
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Telephone | 787-587-6195
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15486
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301113879
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN247
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License Number State | FL
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