Provider Demographics
NPI:1376626937
Name:JOSEPH, SOVI (MD PA)
Entity Type:Individual
Prefix:
First Name:SOVI
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 TAMIAMI TRL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8134
Mailing Address - Country:US
Mailing Address - Phone:941-258-9500
Mailing Address - Fax:941-258-9501
Practice Address - Street 1:3440 TAMIAMI TRL
Practice Address - Street 2:SUITE 1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8134
Practice Address - Country:US
Practice Address - Phone:941-258-9500
Practice Address - Fax:941-258-9501
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77185207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49257OtherBCBS FL
C05100Medicare UPIN
FL49257WMedicare PIN