Pensacola Bone & Joint Clinic PA

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

ME0053867 Issued in FL

Legal business name

PENSACOLA BONE & JOINT CLINIC PA

Practice address

5147 N 9TH Ave
Suite 110
Pensacola, FL 32504-8771

Phone

(850) 479-7229

Fax

(850) 479-7250

NPI assigned

Aug 23, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Theodore Dejong, MD

Title

President

Phone

(850) 479-7229

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250726400000",
    "number": "1104819499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5147 N 9TH AVE",
            "address_2": "SUITE 110",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048771",
            "telephone_number": "850-479-7229",
            "fax_number": "850-479-7250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5147 N 9TH AVE",
            "address_2": "SUITE 110",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048771",
            "telephone_number": "850-479-7229",
            "fax_number": "850-479-7250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENSACOLA BONE & JOINT CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2009-08-20",
        "status": "A",
        "authorized_official_last_name": "DEJONG",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "THEODORE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-479-7229",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "FL",
            "license": "ME0053867",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "TX",
            "license": "L1829",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "251235100",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009920660",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "32487",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery Physician in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Orthopaedic Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.