MEDICARE: DR. JESSY CASIMIRO 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	207Q00000X	Family Medicine Physician	ME0069181	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

General Provider Information

NPI Number	:	1639157902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSY CASIMIRO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 730729
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32173-0729
Country	:	US
Telephone Number	:	386-673-9790
Fax Number	:	386-672-9904

Provider Business Practice Location Address
First Line	:	290 CLYDE MORRIS BLVD
Second Line	:	SUITE A2
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8130
Country	:	US
Telephone Number	:	386-673-9790
Fax Number	:

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	03/10/2011

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