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NPI Code Detail

MEDICARE: ROBERTO JO M.D.

MEDICARE: ROBERTO JO 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
1208M00000XHospitalist PhysicianME93289FL
2207R00000XInternal Medicine PhysicianME93289FL

Other Identifiers

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

General Provider Information

NPI Number : 1629042403
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTO JO M.D.
Provider Business Mailing Address
First Line : 1200 RIVERPLACE BLVD
Second Line : SUITE 620
City : JACKSONVILLE
State : FL
Zip : 32207-9046
Country : US
Telephone Number : 904-396-6620
Fax Number : 904-396-6528
Provider Business Practice Location Address
First Line : 1200 RIVERPLACE BLVD
Second Line : SUITE 620
City : JACKSONVILLE
State : FL
Zip : 32207-9046
Country : US
Telephone Number : 904-396-6620
Fax Number : 904-396-6528
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2006
Last Update Date : 11/12/2024

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