Distasio, John
Distasio, John is an individual health care provider with primary practice located at 4751 S Cleveland Ave , Fort Myers FL 33907. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Distasio, John can be contacted via phone (239) 343-9888.Contact Information
Primary practice address
4751 S Cleveland Ave
Fort Myers FL 33907
Phone: (239) 343-9888
Fax: (239) 343-9868
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | ME57595 | Florida |
Profile Details
| NPI number | 1457351611 |
|---|---|
| LBN Legal business name | Distasio, John |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 28th, 2005 |
| Last updated | Mar 25th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457351611 | NPPES |
| Florida | MEDICAID | 063826900 |
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