Provider Demographics
NPI:1033197504
Name:DEVINE, JOHN B II (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:DEVINE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 COMMERCIAL CT STE E
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1623
Mailing Address - Country:US
Mailing Address - Phone:941-457-7700
Mailing Address - Fax:941-220-3327
Practice Address - Street 1:375 COMMERCIAL CT STE E
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1623
Practice Address - Country:US
Practice Address - Phone:941-457-7700
Practice Address - Fax:941-220-3327
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065372207VG0400X
OH35-065372208800000X
FLME125455207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHJO0875011OtherMEDICARE ID
OH4259931OtherMEDICARE ID
FL016370600Medicaid
F65285Medicare UPIN