Healthcare Provider Details

I. General information

NPI: 1639320880
Provider Name (Legal Business Name): JOSEPH JOHN BEDWAY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14430 US HIGHWAY 1 STE 101
SEBASTIAN FL
32958-3289
US

IV. Provider business mailing address

14430 US HIGHWAY 1 STE 101
SEBASTIAN FL
32958-3289
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-8003
  • Fax: 772-581-8005
Mailing address:
  • Phone: 772-581-8003
  • Fax: 772-581-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME116202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: