Provider Demographics
NPI:1366657447
Name:HALPERN, JOSHUA ABRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ABRAHAM
Last Name:HALPERN
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 1:4214 N HABANA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6314
Mailing Address - Country:US
Mailing Address - Phone:813-872-2696
Mailing Address - Fax:813-872-0268
Practice Address - Street 1:4214 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6314
Practice Address - Country:US
Practice Address - Phone:813-872-2696
Practice Address - Fax:813-872-0268
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00543082086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE67462Medicare UPIN