Provider Demographics
NPI:1699011940
Name:MAYER, JOHN RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RONALD
Last Name:MAYER
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 1:730 S COLLIER BLVD
Mailing Address - Street 2:UNIT 106
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-6021
Mailing Address - Country:US
Mailing Address - Phone:239-821-4398
Mailing Address - Fax:
Practice Address - Street 1:730 S COLLIER BLVD
Practice Address - Street 2:UNIT 106
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-6021
Practice Address - Country:US
Practice Address - Phone:239-821-4398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027119A208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery