Provider Demographics
NPI:1366752552
Name:JOANNE D SAXOUR MD
Entity type:Organization
Organization Name:JOANNE D SAXOUR MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SAXOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-756-4488
Mailing Address - Street 1:790 DUNLAWTON AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4222
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:SUITE G
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4222
Practice Address - Country:US
Practice Address - Phone:386-756-4488
Practice Address - Fax:386-788-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty