Provider Demographics
NPI:1275614612
Name:KAVANAGH, JOSEPH JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JAMES
Last Name:KAVANAGH
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 1:21 COCONUT LN
Mailing Address - Street 2:
Mailing Address - City:OCEAN RIDGE
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5202
Mailing Address - Country:US
Mailing Address - Phone:305-331-9580
Mailing Address - Fax:
Practice Address - Street 1:21 COCONUT LN
Practice Address - Street 2:
Practice Address - City:OCEAN RIDGE
Practice Address - State:FL
Practice Address - Zip Code:33435-5202
Practice Address - Country:US
Practice Address - Phone:305-331-9580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00112912085R0202X
KS04-332592085R0202X
FL4141642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200111561Medicaid
KS30004827960001Medicaid