MEDICARE: JOHN A PRODOEHL 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	207X00000X	Orthopaedic Surgery Physician	ME162392	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	:	1750494340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A PRODOEHL M.D.

Provider Business Mailing Address
First Line	:	740 W PLYMOUTH AVE
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-3282
Country	:	US
Telephone Number	:	386-734-9122
Fax Number	:

Provider Business Practice Location Address
First Line	:	617 CANAL ST STE 110
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-6901
Country	:	US
Telephone Number	:	386-734-9122
Fax Number	:

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	05/29/2025

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Directions to “ JOHN A PRODOEHL M.D.” Practice Location

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