Provider Demographics
NPI:1508892563
Name:KATTA, JOSEPH JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOSEPH
Last Name:KATTA
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 1:1900 NEBRASKA AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4837
Mailing Address - Country:US
Mailing Address - Phone:772-466-7200
Mailing Address - Fax:772-466-9513
Practice Address - Street 1:1900 NEBRASKA AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4837
Practice Address - Country:US
Practice Address - Phone:772-466-7200
Practice Address - Fax:772-466-9513
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0047323207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56167Medicare ID - Type Unspecified
FLFL-D56786Medicare UPIN