Healthcare Provider Details

I. General information

NPI: 1386637387
Provider Name (Legal Business Name): JOSEPH A HEGLEH MD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3195 TAMIAMI TRL SUITE B
PORT CHARLOTTE FL
33952-8029
US

IV. Provider business mailing address

3195 TAMIAMI TRL SUITE B
PORT CHARLOTTE FL
33952-8029
US

V. Phone/Fax

Practice location:
  • Phone: 941-883-2020
  • Fax: 941-883-3938
Mailing address:
  • Phone: 941-883-2020
  • Fax: 941-883-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number81459
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: