MEDICARE: JOSEPH J DAVERSA JR MD PA

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	2084P0800X	Psychiatry Physician	ME 0014994	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	:	1952377764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH J DAVERSA JR MD PA

Provider Business Mailing Address
First Line	:	12368 SW 82ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-5223
Country	:	US
Telephone Number	:	305-253-4218
Fax Number	:	305-233-5844

Provider Business Practice Location Address
First Line	:	12368 SW 82ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-5223
Country	:	US
Telephone Number	:	305-253-4218
Fax Number	:	305-233-5844

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH JAMES DAVERSA JR.
Credential	:	MD
Telephone Number	:	305-253-4218

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	03/30/2011

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