MEDICARE: JOHN ASSI, MD, PA

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	208000000X	Pediatrics Physician	MH45615	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	:	1902079395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN ASSI, MD, PA

Provider Business Mailing Address
First Line	:	3710 GRANDY AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-6112
Country	:	US
Telephone Number	:	904-398-1471
Fax Number	:	904-398-1460

Provider Business Practice Location Address
First Line	:	1346 MASON AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5508
Country	:	US
Telephone Number	:	386-323-0550
Fax Number	:	386-323-0510

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN ASSI
Credential	:	MD
Telephone Number	:	904-398-1471

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	11/25/2008

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