Provider Demographics
NPI:1124078530
Name:JOSEPH, ANTHONY P (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 HEALTH CARE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8334
Mailing Address - Country:US
Mailing Address - Phone:386-753-0000
Mailing Address - Fax:386-753-0001
Practice Address - Street 1:793 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8334
Practice Address - Country:US
Practice Address - Phone:386-753-0000
Practice Address - Fax:386-753-0001
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251008100Medicaid
FL110183295OtherRAILROAD MEDICARE
FL32486OtherBLUECROSS BLUESHEILD
FL32486OtherBLUECROSS BLUESHEILD
FLG40282Medicare UPIN