Healthcare Provider Details

I. General information

NPI: 1750310223
Provider Name (Legal Business Name): JOSEPH F CONDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 TAMIAMI TRL STE A
PORT CHARLOTTE FL
33952-8158
US

IV. Provider business mailing address

3417 TAMIAMI TRL STE A
PORT CHARLOTTE FL
33952-8158
US

V. Phone/Fax

Practice location:
  • Phone: 941-344-9249
  • Fax: 941-827-8412
Mailing address:
  • Phone: 941-626-5291
  • Fax: 877-349-5062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number17334
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME148837
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME148837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: