Provider Demographics
NPI:1104027796
Name:MAYO, JAMES LEIGHTON (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEIGHTON
Last Name:MAYO
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 1:8725 N WICKHAM RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2240
Mailing Address - Country:US
Mailing Address - Phone:407-821-3555
Mailing Address - Fax:407-821-3556
Practice Address - Street 1:8725 N WICKHAM RD STE 203
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2240
Practice Address - Country:US
Practice Address - Phone:407-821-3555
Practice Address - Fax:407-821-3556
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1281682086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017623900Medicaid
FLME128168OtherMEDICAL LICENSE
FLME128168OtherMEDICAL LICENSE