Provider Demographics
NPI:1578545737
Name:MOKULIS, JOSEPH ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:MOKULIS
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 1:541 W COLLEGE ST
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5323
Mailing Address - Country:US
Mailing Address - Phone:256-766-6026
Mailing Address - Fax:256-766-6345
Practice Address - Street 1:541 W COLLEGE ST
Practice Address - Street 2:SUITE 3300
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5323
Practice Address - Country:US
Practice Address - Phone:256-766-6026
Practice Address - Fax:256-766-6345
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21537208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL40881OtherBC
AL000040881Medicaid
AL000040881Medicare PIN
G70233Medicare UPIN