MEDICARE: PROSPER JOSEPH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	RPHT3903	FL
2	103TP0016X	Prescribing (Medical) Psychologist	2343212	FL

General Provider Information

NPI Number	:	1881001972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROSPER JOSEPH M.D.

Provider Business Mailing Address
First Line	:	1774 15TH AVE N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-1734
Country	:	US
Telephone Number	:	407-965-9329
Fax Number	:	786-272-0476

Provider Business Practice Location Address
First Line	:	1774 15TH AVE N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-1734
Country	:	US
Telephone Number	:	407-965-9329
Fax Number	:	786-272-0476

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	01/19/2017

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Directions to “ PROSPER JOSEPH M.D.” Practice Location

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