Provider Demographics
NPI:1427012095
Name:DREWNIANY, JOHN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:DREWNIANY
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 1:14546 SAINT AUGUSTINE RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5468
Mailing Address - Country:US
Mailing Address - Phone:904-262-8442
Mailing Address - Fax:904-262-8482
Practice Address - Street 1:14546 SAINT AUGUSTINE RD
Practice Address - Street 2:SUITE 405
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5468
Practice Address - Country:US
Practice Address - Phone:904-262-8442
Practice Address - Fax:904-262-8482
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046416174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042349100Medicaid
FL1285680231OtherNPI
FL0506200001Medicare NSC
FL1427012095Medicare PIN
FL042349100Medicaid