Provider Demographics
NPI:1992770283
Name:RIZZO, JASPER J (DO)
Entity type:Individual
Prefix:
First Name:JASPER
Middle Name:J
Last Name:RIZZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-2030
Mailing Address - Fax:239-343-4116
Practice Address - Street 1:507 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2618
Practice Address - Country:US
Practice Address - Phone:239-424-2030
Practice Address - Fax:239-343-4116
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6277208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL207496OtherAMERIGROUP PROVIDER NUM.
FL16024OtherWELLCARE
FL4234606OtherAETNA PROVIDER NUMBER
FL0829612-005OtherCIGNA PROVIDER NUMBER
FL37205OtherOP. ENGIN. PROVIDER #
FL370916700Medicaid
FL739121OtherFIRST HLTH/CCN PROV. #
FL258028OtherAVMED PROVIDER NUMBER
FL256184OtherUSA MNGD. CR. PROV. #
FL80602OtherBCBS PROVIDER NUMBER
FLOS6277OtherMETCARE PROVIDER NUMBER
FLP01567037OtherRR MEDICARE
FLP01567037OtherRR MEDICARE
FLF23138Medicare UPIN