MEDICARE: JUSTIN BOCCARDO M.D.

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	2086S0129X	Vascular Surgery Physician	MD432316	PA
2	2086S0129X	Vascular Surgery Physician	ME125876	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598887275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN BOCCARDO M.D.

Provider Business Mailing Address
First Line	:	2401 FRIST BLVD STE 4
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4800
Country	:	US
Telephone Number	:	772-595-5302
Fax Number	:	772-595-5304

Provider Business Practice Location Address
First Line	:	2401 FRIST BLVD STE 4
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4800
Country	:	US
Telephone Number	:	772-595-5302
Fax Number	:	772-595-5304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	02/10/2022

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Directions to “ JUSTIN BOCCARDO M.D.” Practice Location

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