Provider Demographics
NPI:1699126102
Name:REXROAT, JOSEPH AVERY (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:AVERY
Last Name:REXROAT
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 1:1105 SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2345
Mailing Address - Country:US
Mailing Address - Phone:231-252-0068
Mailing Address - Fax:
Practice Address - Street 1:921 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2327
Practice Address - Country:US
Practice Address - Phone:231-252-0068
Practice Address - Fax:231-213-8729
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301117095207Q00000X
MI4351036924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine