Provider Demographics
NPI:1407891302
Name:OKUN AND MADDALON M.D. PA
Entity Type:Organization
Organization Name:OKUN AND MADDALON M.D. PA
Other - Org Name:BRANDON ORTHOPEDICS ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:OKUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-684-3707
Mailing Address - Street 1:721 W ROBERTSON ST
Mailing Address - Street 2:STE 102
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4934
Mailing Address - Country:US
Mailing Address - Phone:813-684-3707
Mailing Address - Fax:813-643-2457
Practice Address - Street 1:721 W ROBERTSON ST
Practice Address - Street 2:STE 102
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4934
Practice Address - Country:US
Practice Address - Phone:813-684-3707
Practice Address - Fax:813-654-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97526Medicare PIN
FL0415840001Medicare NSC