Healthcare Provider Details

I. General information

NPI: 1902884299
Provider Name (Legal Business Name): JOSEPH WELLS AGUIAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12015 WHITMARSH LN
TAMPA FL
33626-1737
US

IV. Provider business mailing address

12015 WHITMARSH LN
TAMPA FL
33626-1737
US

V. Phone/Fax

Practice location:
  • Phone: 813-658-3600
  • Fax: 813-739-0917
Mailing address:
  • Phone: 813-658-3600
  • Fax: 813-739-0917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME82789
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number31448
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberME82789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: