Provider Demographics
NPI:1316012214
Name:JOHN A ONDREJICKA MD PA
Entity Type:Organization
Organization Name:JOHN A ONDREJICKA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ONDREJICKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-241-5331
Mailing Address - Street 1:700 3RD ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-5072
Mailing Address - Country:US
Mailing Address - Phone:904-241-5331
Mailing Address - Fax:904-270-0233
Practice Address - Street 1:700 3RD ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5072
Practice Address - Country:US
Practice Address - Phone:904-241-5331
Practice Address - Fax:904-270-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54154207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08599Medicare ID - Type UnspecifiedFL MEDICARE (INDIVIDUAL)