Individual
DR. JOHN ANTHONY MANSOUR JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4689 US HIGHWAY 17 STE 12, FLEMING ISLAND, FL 32003-4831
(904) 375-9753
(904) 375-8380
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
(706) 494-3008
Taxonomy
Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
020005101A
IN
207XX0801X
Orthopaedic Trauma Physician
Primary
OS14658
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OS14658
FL MEDICAL LICENSE
FL
Enumeration date
10/28/2010
Last updated
03/07/2023
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