Florida Mens Vitality Center Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

FLORIDA MENS VITALITY CENTER INC

Practice address

28901 Trails Edge Blvd Ste 202
Bonita Springs, FL 34134-7588

Phone

(239) 220-1083

NPI assigned

Jan 23, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Paul Joseph Dejohn Jr.

Title

President

Phone

(239) 220-1083

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548201600000",
    "number": "1598229536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28901 TRAILS EDGE BLVD STE 202",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341347588",
            "telephone_number": "239-220-1083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28901 TRAILS EDGE BLVD STE 202",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341347588",
            "telephone_number": "239-220-1083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA MENS VITALITY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-23",
        "last_updated": "2019-01-23",
        "status": "A",
        "authorized_official_last_name": "DEJOHN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-220-1083",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; 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.