Healthcare Provider Details

I. General information

NPI: 1588093512
Provider Name (Legal Business Name): JOSEPH PAUL BANDEIRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 9TH ST N STE 110
NAPLES FL
34102-5886
US

IV. Provider business mailing address

311 9TH ST N STE 110
NAPLES FL
34102-5886
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-0940
  • Fax:
Mailing address:
  • Phone: 239-624-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number01076955A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME133171
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: