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NPI Code Detail

MEDICARE: MR. JOHN WAYNE ROYALTY DO

MEDICARE: MR. JOHN WAYNE ROYALTY DO
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
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician056237FL

Other Identifiers

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

General Provider Information

NPI Number : 1649274259
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN WAYNE ROYALTY DO
Provider Business Mailing Address
First Line : 3402 N LECANTO HWY
Second Line : STE C
City : BEVERLY HILLS
State : FL
Zip : 34465-3570
Country : US
Telephone Number : 352-563-5488
Fax Number : 352-563-6328
Provider Business Practice Location Address
First Line : 3402 N LECANTO HWY
Second Line : STE C
City : BEVERLY HILLS
State : FL
Zip : 34465-3570
Country : US
Telephone Number : 352-563-5488
Fax Number : 352-563-6328
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 02/06/2015

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