Provider Demographics
NPI:1558548586
Name:WAHL, JOANNA P (DO)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:P
Last Name:WAHL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5858 SW 68TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3693
Mailing Address - Country:US
Mailing Address - Phone:305-661-8588
Mailing Address - Fax:305-661-4906
Practice Address - Street 1:5858 SW 68TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3693
Practice Address - Country:US
Practice Address - Phone:305-357-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI510101017234207W00000X
FLOS11370207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology