1538188115 NPI number — DR. JON F SWEET MD

Table of content: DR. JON F SWEET MD (NPI 1538188115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538188115 NPI number — DR. JON F SWEET MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEET
Provider First Name:
JON
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538188115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4932 W STATE ROAD 46 STE 1090
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32771-9244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-635-3340
Provider Business Mailing Address Fax Number:
407-636-7852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4932 W STATE ROAD 46 STE 1090
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-635-3340
Provider Business Practice Location Address Fax Number:
407-636-7852
Provider Enumeration Date:
07/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  ME64008 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 372984200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18952 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00387706 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".