Provider Demographics
NPI:1699866467
Name:FOGEL, JOSEPH P (MD)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:P
Last Name:FOGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:824 BAY AVE
Mailing Address - Street 2:STE 70
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2104
Mailing Address - Country:US
Mailing Address - Phone:831-464-6200
Mailing Address - Fax:831-464-6204
Practice Address - Street 1:824 BAY AVE
Practice Address - Street 2:STE 70
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2104
Practice Address - Country:US
Practice Address - Phone:831-464-6200
Practice Address - Fax:831-464-6204
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35774207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A357740Medicaid
CAA27901Medicare UPIN
CA00A357740Medicaid