Provider Demographics
NPI:1073579793
Name:JUSINO, JOHN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:JUSINO
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 1:1300 MICCOSUKEE ROAD
Mailing Address - Street 2:TALLAHASSEE MEM BIXLER EMG CTR
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5095
Mailing Address - Country:US
Mailing Address - Phone:850-431-0911
Mailing Address - Fax:850-431-0799
Practice Address - Street 1:1300 MICCOSUKEE RD
Practice Address - Street 2:BIXLER EMERGENCY CENTER
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5054
Practice Address - Country:US
Practice Address - Phone:850-431-0756
Practice Address - Fax:850-431-0779
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME65193207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374632100Medicaid
FLD29891Medicare UPIN
FL374632100Medicaid