Provider Demographics
NPI:1801927579
Name:MIGNOGNA, JOSEPH JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:MIGNOGNA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:677 DAVE NISBET DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-4528
Mailing Address - Country:US
Mailing Address - Phone:321-868-3949
Mailing Address - Fax:321-868-5520
Practice Address - Street 1:677 DAVE NISBET DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-4528
Practice Address - Country:US
Practice Address - Phone:321-868-3949
Practice Address - Fax:321-868-5520
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME450722083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E15405Medicare UPIN