Provider Demographics
NPI:1225065014
Name:RIZZOLO, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:RIZZOLO
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 1:160 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3908
Mailing Address - Country:US
Mailing Address - Phone:406-260-7604
Mailing Address - Fax:
Practice Address - Street 1:421 KINGSLEY AVE STE 402
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4898
Practice Address - Country:US
Practice Address - Phone:904-264-8801
Practice Address - Fax:904-621-0566
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143567207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1225065014Medicaid
MT000006101OtherBLUE CROSS
MT0099424Medicaid
AZ433416Medicaid
MT1225065014Medicaid
MT000008429Medicare PIN
MT011002185Medicare PIN