Healthcare Provider Details

I. General information

NPI: 1245629542
Provider Name (Legal Business Name): JOSHUA & JOSHUA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2015
Last Update Date: 01/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 VIA POINCIANA SUITE 1
LAKE WORTH FL
33467-2991
US

IV. Provider business mailing address

3918 VIA POINCIANA SUITE 1
LAKE WORTH FL
33467-2991
US

V. Phone/Fax

Practice location:
  • Phone: 561-439-4682
  • Fax: 561-968-0483
Mailing address:
  • Phone: 561-439-4682
  • Fax: 561-968-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME39021
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME39190
License Number StateFL

VIII. Authorized Official

Name: LYNNE LEROSE
Title or Position: OFFICE MANAGER
Credential:
Phone: 561-439-4682