Healthcare Provider Details

I. General information

NPI: 1598405706
Provider Name (Legal Business Name): JOEL JAVIER CARDONA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOEL CARDONA VAZQUEZ DPM

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 CRESTHAVEN RD STE 110
MEMPHIS TN
38119-0845
US

IV. Provider business mailing address

1068 CRESTHAVEN RD STE 300
MEMPHIS TN
38119-0809
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-5620
  • Fax: 901-763-4326
Mailing address:
  • Phone: 901-866-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number978
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: