Provider Demographics
NPI:1972606929
Name:STASIO, JOSEPH MARIO (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARIO
Last Name:STASIO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3200 S UNIVERSITY DRIVE
Mailing Address - Street 2:NOVA SOUTHEASTERN UNIVERSITY DEPARTMENT OF FAMILY MEDIC
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-262-1449
Mailing Address - Fax:954-262-3753
Practice Address - Street 1:3200 S UNIVERSITY DRIVE
Practice Address - Street 2:NOVA SOUTHEASTERN UNIVERSITY DEPARTMENT OF FAMILY MEDIC
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-262-1449
Practice Address - Fax:954-262-3753
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL0S6371207Q00000X
CO31994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
80748Medicare ID - Type Unspecified
F48080Medicare UPIN