Provider Demographics
NPI:1952978678
Name:BOCINSKY, JOHN DANIEL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DANIEL
Last Name:BOCINSKY
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 1:240 N WICKHAM RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8663
Mailing Address - Country:US
Mailing Address - Phone:321-541-1777
Mailing Address - Fax:321-541-1788
Practice Address - Street 1:240 N WICKHAM RD STE 108
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8663
Practice Address - Country:US
Practice Address - Phone:321-541-1777
Practice Address - Fax:321-541-1788
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021021435207Q00000X
FLME168464207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine