Provider Demographics
NPI:1205843836
Name:JOSEPH, BRIAN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PATRICK
Last Name:JOSEPH
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 1:340 N WYMORE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2823
Mailing Address - Country:US
Mailing Address - Phone:407-673-3223
Mailing Address - Fax:407-772-3223
Practice Address - Street 1:340 N WYMORE RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2823
Practice Address - Country:US
Practice Address - Phone:407-673-3223
Practice Address - Fax:407-772-3223
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64574174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267080100Medicaid
FLK4248Medicare ID - Type UnspecifiedGROUP #
FL267080100Medicaid