Provider Demographics
NPI:1801848478
Name:BAYOLO, JUAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
Last Name:BAYOLO
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 1:3131 EGRETS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-7419
Mailing Address - Country:US
Mailing Address - Phone:787-587-6195
Mailing Address - Fax:
Practice Address - Street 1:1565 SAXON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5823
Practice Address - Country:US
Practice Address - Phone:386-574-1423
Practice Address - Fax:321-684-5212
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301113879208D00000X
PR15486207Q00000X
FLACN247208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101229200Medicaid
HQ793ZOtherMEDICARE ID
HQ793ZOtherMEDICARE ID
FLI24161Medicare UPIN