Provider Demographics
NPI:1598267593
Name:JOSEPH D STILLWORD, MD
Entity Type:Organization
Organization Name:JOSEPH D STILLWORD, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:STILLWORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-328-9977
Mailing Address - Street 1:800 ZEAGLER DR STE 320
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3827
Mailing Address - Country:US
Mailing Address - Phone:386-328-9977
Mailing Address - Fax:386-329-1953
Practice Address - Street 1:800 ZEAGLER DR STE 320
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3827
Practice Address - Country:US
Practice Address - Phone:386-328-9977
Practice Address - Fax:386-329-1953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME468852086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty