MEDICARE: JOANNE D SAXOUR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME83465	FL

General Provider Information

NPI Number	:	1366752552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANNE D SAXOUR MD

Provider Business Mailing Address
First Line	:	790 DUNLAWTON AVE
Second Line	:	SUITE G
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4222
Country	:	US
Telephone Number	:	386-756-4488
Fax Number	:	386-788-2026

Provider Business Practice Location Address
First Line	:	790 DUNLAWTON AVE
Second Line	:	SUITE G
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4222
Country	:	US
Telephone Number	:	386-756-4488
Fax Number	:	386-788-2026

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	JOANNE D SAXOUR
Credential	:	M.D.
Telephone Number	:	386-756-4488

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	12/09/2010

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