Healthcare Provider Details

I. General information

NPI: 1699763516
Provider Name (Legal Business Name): JOSEPH RICHARD ASIAF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 OAK ST SUITE A
BROCKTON MA
02301-1341
US

IV. Provider business mailing address

370 OAK ST SUITE A
BROCKTON MA
02301-1341
US

V. Phone/Fax

Practice location:
  • Phone: 508-584-1234
  • Fax: 508-584-0230
Mailing address:
  • Phone: 508-584-1234
  • Fax: 508-584-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28516
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: