Provider Demographics
NPI:1811963341
Name:SAXOUR, JOANNE DEAUSEN (MD)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:DEAUSEN
Last Name:SAXOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:MARIE
Other - Last Name:DEAUSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:790 DUNLAWTON AVE
Mailing Address - Street 2:STE G
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127
Mailing Address - Country:US
Mailing Address - Phone:386-756-4488
Mailing Address - Fax:386-788-2026
Practice Address - Street 1:790 DUNLAWTON AVE
Practice Address - Street 2:STE G
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127
Practice Address - Country:US
Practice Address - Phone:386-756-4488
Practice Address - Fax:386-788-2026
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266251500Medicaid
P00008393OtherMEDICARE RAILROAD
57833OtherBLUE CROSS BLUE SHIELD
57833OtherBLUE CROSS BLUE SHIELD
P00008393OtherMEDICARE RAILROAD
U0051DMedicare ID - Type Unspecified