Provider Demographics
NPI:1285716027
Name:DEFEO, JOSEPH WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:DEFEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:21 BILLINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-1029
Mailing Address - Country:US
Mailing Address - Phone:850-457-4498
Mailing Address - Fax:
Practice Address - Street 1:6000 HIGHWAY 98 WEST
Practice Address - Street 2:NAVAL HOSPITAL PENSACOLA
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512
Practice Address - Country:US
Practice Address - Phone:850-505-6261
Practice Address - Fax:850-505-6548
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022116-E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery