Provider Demographics
NPI:1619911070
Name:WIDDOWS, JOANNA (DO)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:WIDDOWS
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 1:13660 JOG RD
Mailing Address - Street 2:SUITE B5
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3806
Mailing Address - Country:US
Mailing Address - Phone:561-498-7474
Mailing Address - Fax:561-819-6466
Practice Address - Street 1:13660 JOG RD
Practice Address - Street 2:SUITE B5
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3806
Practice Address - Country:US
Practice Address - Phone:561-498-7474
Practice Address - Fax:561-819-6466
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47267OtherBLUE CROSS
FL269340200Medicaid
FL7941080OtherAETNA
FL7941080OtherAETNA
FLHO6855Medicare UPIN