=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063547511
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH JAMES STRAIGHT M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2007
-----------------------------------------------------
Last Update Date | 01/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4745 OGLETOWN STANTON RD STE 225
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19713-1387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-731-2888
-----------------------------------------------------
Fax | 302-731-7049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 EXECUTIVE DR STE 11
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19702-3358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-731-2888
-----------------------------------------------------
Fax | 302-731-7049
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QS0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | C1-0008348
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------