Provider Demographics
NPI:1396721221
Name:DECOSMO, JOHN B (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:DECOSMO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:4800 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3817
Mailing Address - Country:US
Mailing Address - Phone:727-498-6488
Mailing Address - Fax:727-362-6772
Practice Address - Street 1:4800 4TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3817
Practice Address - Country:US
Practice Address - Phone:727-698-2056
Practice Address - Fax:727-541-3956
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2025-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS5534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0493287 00Medicaid
E31898Medicare UPIN