Provider Demographics
NPI:1609890045
Name:DESAMOUR, JUNIAS (MD)
Entity Type:Individual
Prefix:
First Name:JUNIAS
Middle Name:
Last Name:DESAMOUR
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 1:425 S HUNT CLUB BLVD
Mailing Address - Street 2:SUITE 2001
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4947
Mailing Address - Country:US
Mailing Address - Phone:407-705-3636
Mailing Address - Fax:407-809-5222
Practice Address - Street 1:425 S HUNT CLUB BLVD
Practice Address - Street 2:SUITE 2001
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4947
Practice Address - Country:US
Practice Address - Phone:407-705-3636
Practice Address - Fax:407-809-5222
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 86952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH84583Medicare UPIN