Provider Demographics
NPI:1336333681
Name:VENZON, ROY PASCUAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:PASCUAL
Last Name:VENZON
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 1:695 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2321
Mailing Address - Country:US
Mailing Address - Phone:386-258-8722
Mailing Address - Fax:386-258-8659
Practice Address - Street 1:938 SAXON BLVD STE 101-C
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8305
Practice Address - Country:US
Practice Address - Phone:386-774-5485
Practice Address - Fax:386-775-0761
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120286207RI0011X, 2086S0129X, 207RC0000X, 207UN0901X
IA37455207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBCBSOtherBCBS 14ZS2
IAP00709135OtherRR MEDICARE AT STL
FL14749000Medicaid
FL0045Medicare PIN
FLBCBSOtherBCBS 14ZS2
FL40097Medicare PIN