MEDICARE: DR. JOSEPH HERVE ETIENNE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME 94948	FL
2	207RI0200X	Infectious Disease Physician	ME0094948	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134145618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH HERVE ETIENNE MD

Provider Business Mailing Address
First Line	:	20423 STATE ROAD 7 STE F6 #287
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33498-6792
Country	:	US
Telephone Number	:	561-995-6971
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 S CONGRESS AVE STE 201
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-6637
Country	:	US
Telephone Number	:	561-995-6971
Fax Number	:	561-569-8309

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	08/17/2021

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