Basic Information
Provider Information | |||||||||
NPI: | 1245629542 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | JOSHUA & JOSHUA MD PA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3918 VIA POINCIANA | ||||||||
Address2: | SUITE 1 | ||||||||
City: | LAKE WORTH | ||||||||
State: | FL | ||||||||
PostalCode: | 334672991 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5614394682 | ||||||||
FaxNumber: | 5619680483 | ||||||||
Practice Location | |||||||||
Address1: | 3918 VIA POINCIANA | ||||||||
Address2: | SUITE 1 | ||||||||
City: | LAKE WORTH | ||||||||
State: | FL | ||||||||
PostalCode: | 334672991 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5614394682 | ||||||||
FaxNumber: | 5619680483 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/10/2015 | ||||||||
LastUpdateDate: | 01/10/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LEROSE | ||||||||
AuthorizedOfficialFirstName: | LYNNE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
AuthorizedOfficialTelephone: | 5614394682 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | ME39190 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RH0003X | ME39021 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | 049594800 | 05 | FL |   | MEDICAID | 066183000 | 05 | FL |   | MEDICAID |