Healthcare Provider Details

I. General information

NPI: 1629082383
Provider Name (Legal Business Name): JOSEPH LOCICERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N BAYOU ST
MOBILE AL
36603-5827
US

IV. Provider business mailing address

1158 CHURCH ST
MOBILE AL
36604-2936
US

V. Phone/Fax

Practice location:
  • Phone: 251-690-8158
  • Fax: 251-544-2188
Mailing address:
  • Phone: 251-432-4373
  • Fax: 251-432-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number60 241117
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number60 241117
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number60 241117
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 24943
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: