Organization
V JOHN D SOUZA MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT COOLIDGE (AGENT/REPRESENTATIVE)
(386) 774-5211
Entity
Organization
Contact information
Practice address
576 STERTHAUS AVE, SUITE A, ORMOND BEACH, FL 32174-5128
(386) 677-5674
Mailing address
PO BOX 741240, ORANGE CITY, FL 32774-1240
(386) 774-5211
(386) 774-5251
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
ME55087
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064866300
—
FL
01
—
11659
BCBS NUMBER
FL
01
—
11659E
MEDICARE INDIVIDUAL PIN
FL
01
—
DE1997
RAILROAD MEDICARE
FL
01
—
P00277876
RAILROAD MEDICARE
—
Enumeration date
08/22/2007
Last updated
09/27/2013
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