Provider Demographics
NPI:1174551949
Name:VIOLA, JOHN JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:VIOLA
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:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0417
Mailing Address - Country:US
Mailing Address - Phone:772-223-5665
Mailing Address - Fax:772-223-5646
Practice Address - Street 1:509 SE RIVERSIDE DR
Practice Address - Street 2:STE 203
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2579
Practice Address - Country:US
Practice Address - Phone:772-288-5862
Practice Address - Fax:772-288-5874
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38706207T00000X
FLME102413207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000464400Medicaid
FL000464400Medicaid
FLAS438Medicare PIN
CO186853900OtherOCCUPATION FEDERAL WORK C
COG26342Medicare UPIN
CO841267829OtherTAX ID
CO84126782914OtherMOUNTAIN SHADOWS PACIFICA
CO140007545OtherRAILROAD MEDICARE
CO38706OtherPINNACOL ASSURANCE
CO00016849OtherBANNER HEALTH
CO22096OtherSECURE HORIZON
CO84126782914OtherPACIFICARE
FLAS438Medicare PIN
COVI642097OtherBLUE CROSS BLUE SHIELD
FL000464400Medicaid
WY111732700Medicaid
WY111732700Medicaid