Provider Demographics
NPI:1154318012
Name:MIGNONE, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MIGNONE
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 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1235 SAN MARCO BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207
Practice Address - Country:US
Practice Address - Phone:904-493-5100
Practice Address - Fax:904-493-5130
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79920207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273639OtherAVMED
GA849494350EMedicaid
FLP01593281OtherRRMEDICARE
FL1034496OtherCAREPLUS
FL1193403OtherWELLCARE
FL2623820-00Medicaid
FL51714OtherBCBS
FLP0022944OtherFLORIDA HEALTHCARE PLUS
FL51714SMedicare PIN
FLP01593281OtherRRMEDICARE
FL51714RMedicare PIN
FL1193403OtherWELLCARE
FL51714OtherBCBS