Individual
DR. JOHN M VASSALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3780 US HIGHWAY 1 S, ST AUGUSTINE, FL 32086-7150
(904) 797-7722
Mailing address
PO BOX 1598, ST AUGUSTINE, FL 32085-1598
(904) 797-7722
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME0059092
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12416
BLUE CROSS BLUE SHIELD
FL
05
—
263472400
—
FL
05
—
263472401
—
FL
Enumeration date
08/02/2005
Last updated
08/08/2012
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