Provider Demographics
NPI:1326063900
Name:KAYOMA, JOHN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:KAYOMA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:173 N CHARLES RICHARD BEALL BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2211
Mailing Address - Country:US
Mailing Address - Phone:386-516-9770
Mailing Address - Fax:386-516-9770
Practice Address - Street 1:173 N CHARLES RICHARD BEALL BLVD STE 106
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2211
Practice Address - Country:US
Practice Address - Phone:386-516-9770
Practice Address - Fax:386-516-9770
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2019-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS17503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS587968167BOtherBLUE CROSS OF MS
MS00125084Medicaid
MS01722576Medicaid
FLLG272OtherMEDICARE