Basic Information
| Provider Information | |||||||||
| NPI: | 1942758339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAVERNE | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 CALLE DR LASSISSE | ||||||||
| Address2: | BO PARIS ALTO | ||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006805434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057269772 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5160 S JOHN YOUNG PKWY | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328395022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8446654827 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2016 | ||||||||
| LastUpdateDate: | 11/06/2019 | ||||||||
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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 | 282N00000X | 19476 | PR | N | Hospitals | General Acute Care Hospital | 208D00000X | ACN1118 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.