Healthcare Provider Details

I. General information

NPI: 1811284706
Provider Name (Legal Business Name): JOSEPH JANKE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HOSPITAL AVE
STUART FL
34994
US

IV. Provider business mailing address

6112 SW KEY DEER LANE
PALM CITY FL
34990
US

V. Phone/Fax

Practice location:
  • Phone: 727-223-2300
  • Fax:
Mailing address:
  • Phone: 727-453-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2011012268
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS12756
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: