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General NPI Number Information
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NPI Number | 1952377764
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Entity Type | Organization
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Legal Business Name | JOSEPH J DAVERSA JR MD PA
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 12368 SW 82ND AVE
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City | MIAMI
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State | FL
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Zip | 33156-5223
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Country | US
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Telephone | 305-253-4218
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Fax | 305-233-5844
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Provider Business Mailing Address
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Address Line | 12368 SW 82ND AVE
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City | MIAMI
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State | FL
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Zip | 33156-5223
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Country | US
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Telephone | 305-253-4218
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Fax | 305-233-5844
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH JAMES DAVERSA JR.
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Credential | MD
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Telephone | 305-253-4218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME 0014994
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License Number State | FL
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