Healthcare Provider Details

I. General information

NPI: 1174720734
Provider Name (Legal Business Name): JOSEPH MY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SE OSCEOLA ST STE 301
STUART FL
34994
US

IV. Provider business mailing address

501 SE OSCEOLA ST STE 301
STUART FL
34994-2347
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-5955
  • Fax:
Mailing address:
  • Phone: 772-223-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0102202359
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberOS14909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: