Provider Demographics
NPI:1477567311
Name:NATHAN, JOEL (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:NATHAN
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 1:4400 W SAMPLE RD
Mailing Address - Street 2:SUITE 154
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3470
Mailing Address - Country:US
Mailing Address - Phone:954-782-9330
Mailing Address - Fax:954-977-7401
Practice Address - Street 1:4400 W SAMPLE RD
Practice Address - Street 2:SUITE 154
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3470
Practice Address - Country:US
Practice Address - Phone:954-782-9330
Practice Address - Fax:954-977-7401
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062339207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F35694Medicare UPIN
17819VMedicare ID - Type Unspecified