Provider Demographics
NPI:1043322159
Name:SITES, JOHN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:SITES
Suffix:
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 1:319 GREEN ACRES RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1170
Mailing Address - Country:US
Mailing Address - Phone:850-243-7681
Mailing Address - Fax:850-243-0471
Practice Address - Street 1:319 GREEN ACRES RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-243-7681
Practice Address - Fax:850-243-0471
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0041925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79779Medicaid
FLCH5541OtherRAIL ROAD
D58921Medicare UPIN
FL79779Medicaid
FL4215140001Medicare NSC