Basic Information
| Provider Information | |||||||||
| NPI: | 1366424129 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOSEPH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 E FLETCHER AVE | ||||||||
| Address2: | SUITE 218 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336134708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139108708 | ||||||||
| FaxNumber: | 8139107386 | ||||||||
| Practice Location | |||||||||
| Address1: | 3500 E FLETCHER AVE | ||||||||
| Address2: | SUITE 218 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336134708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139108708 | ||||||||
| FaxNumber: | 8139107386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 01/06/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 15443R | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | ME85229 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1D277336800 | 05 | FL | MEDICAID |