Provider Demographics
NPI:1538122361
Name:STILLWORD, JOSEPH DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DEAN
Last Name:STILLWORD
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 1:800 ZEAGLER DR SUITE 320
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177
Mailing Address - Country:US
Mailing Address - Phone:386-328-9977
Mailing Address - Fax:386-329-1953
Practice Address - Street 1:800 ZEAGLER DR SUITE 320
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177
Practice Address - Country:US
Practice Address - Phone:386-328-9977
Practice Address - Fax:328-329-1953
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046885208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047429100Medicaid
FL04751Medicare ID - Type Unspecified
FL047429100Medicaid