MEDICARE: JOHN ASSI, MD, PA

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	208000000X	Pediatrics Physician	MH45615	FL

General Provider Information

NPI Number	:	1548433931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN ASSI, MD, PA

Provider Business Mailing Address
First Line	:	3710 GRANDY AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-6112
Country	:	US
Telephone Number	:	904-398-1471
Fax Number	:	904-398-1460

Provider Business Practice Location Address
First Line	:	1697 KINGS RD
Second Line	:	SUITE 1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6169
Country	:	US
Telephone Number	:	904-524-8344
Fax Number	:	904-551-1418

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN ASSI
Credential	:	MD
Telephone Number	:	904-398-1471

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	11/03/2015

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