Provider Demographics
NPI:1396858239
Name:ASTAPHAN, JOSEPH ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:ASTAPHAN
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 1:924 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2707
Mailing Address - Country:US
Mailing Address - Phone:954-769-9901
Mailing Address - Fax:954-462-0117
Practice Address - Street 1:924 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2707
Practice Address - Country:US
Practice Address - Phone:954-769-9901
Practice Address - Fax:954-462-0117
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52961207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08943WMedicare ID - Type Unspecified
FLE75814Medicare UPIN