Provider Demographics
NPI:1720486111
Name:SACKETT, JOSEPH FREDERIC SR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FREDERIC
Last Name:SACKETT
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:611 PONTE VEDRA BLVD
Mailing Address - Street 2:UNIT 122
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082
Mailing Address - Country:US
Mailing Address - Phone:904-280-4388
Mailing Address - Fax:904-280-0807
Practice Address - Street 1:611 PONTE VEDRA BLVD
Practice Address - Street 2:UNIT 122
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082
Practice Address - Country:US
Practice Address - Phone:904-280-4388
Practice Address - Fax:904-280-0807
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI18916-20208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice