Basic Information
| Provider Information | |||||||||
| NPI: | 1801848478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAYOLO | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3131 EGRETS LANDING DR | ||||||||
| Address2: | |||||||||
| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327467419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875876195 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1565 SAXON BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | DELTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327255823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3865741423 | ||||||||
| FaxNumber: | 3216845212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 05/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 4301113879 | MI | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | 15486 | PR | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | ACN247 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 101229200 | 05 | FL | MEDICAID | HQ793Z | 01 | MEDICARE ID | OTHER |