Basic Information
| Provider Information | |||||||||
| NPI: | 1154318012 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIGNONE | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2160 COLONIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317342 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Practice Location | |||||||||
| Address1: | 1235 SAN MARCO BLVD | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044935100 | ||||||||
| FaxNumber: | 9044935130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 06/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | ME79920 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 273639 | 01 | FL | AVMED | OTHER | 849494350E | 05 | GA | MEDICAID | P01593281 | 01 | FL | RRMEDICARE | OTHER | 1034496 | 01 | FL | CAREPLUS | OTHER | 1193403 | 01 | FL | WELLCARE | OTHER | 2623820-00 | 05 | FL | MEDICAID | 51714 | 01 | FL | BCBS | OTHER | P0022944 | 01 | FL | FLORIDA HEALTHCARE PLUS | OTHER |