Provider Demographics
NPI:1922298454
Name:IM, JOHN JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:IM
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:11950 COUNTY ROAD 101
Mailing Address - Street 2:SUITE 101
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-9332
Mailing Address - Country:US
Mailing Address - Phone:352-391-5200
Mailing Address - Fax:352-391-5903
Practice Address - Street 1:11950 COUNTY ROAD 101
Practice Address - Street 2:SUITE 101
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-9332
Practice Address - Country:US
Practice Address - Phone:352-391-5200
Practice Address - Fax:352-391-5903
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2009-01-15
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Provider Licenses
StateLicense IDTaxonomies
FLOS8729208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH303235Medicare UPIN
51503XMedicare PIN