Healthcare Provider Details

I. General information

NPI: 1366424129
Provider Name (Legal Business Name): DAVID L JOSEPH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 E FLETCHER AVE SUITE 218
TAMPA FL
33613-4708
US

IV. Provider business mailing address

3500 E FLETCHER AVE SUITE 218
TAMPA FL
33613-4708
US

V. Phone/Fax

Practice location:
  • Phone: 813-910-8708
  • Fax: 813-910-7386
Mailing address:
  • Phone: 813-910-8708
  • Fax: 813-910-7386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number15443R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME85229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: