Provider Demographics
NPI:1497774087
Name:TRANTHAM, JOEY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEY
Middle Name:L
Last Name:TRANTHAM
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 1:625 W BALDWIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3359
Mailing Address - Country:US
Mailing Address - Phone:850-769-0329
Mailing Address - Fax:844-212-7396
Practice Address - Street 1:625 W BALDWIN RD STE C
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3359
Practice Address - Country:US
Practice Address - Phone:850-769-0329
Practice Address - Fax:844-212-7396
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042263174400000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067659400Medicaid
FL17555XMedicare PIN
FL067659400Medicaid