Provider Demographics
NPI:1215935200
Name:LAYSON, JOSEPH SAN JUAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SAN JUAN
Last Name:LAYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HILDA ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2320
Mailing Address - Country:US
Mailing Address - Phone:407-932-6178
Mailing Address - Fax:
Practice Address - Street 1:201 HILDA ST
Practice Address - Street 2:SUITE 204
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2320
Practice Address - Country:US
Practice Address - Phone:407-932-6178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223481208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07389OtherBCBS
FL277400300Medicaid
FLAA897ZMedicare PIN
FL277400300Medicaid