Provider Demographics
NPI:1720222102
Name:JOSEPH, PRAMOD (MD)
Entity Type:Individual
Prefix:
First Name:PRAMOD
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8036 PLANTATION LAKES DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3013
Mailing Address - Country:US
Mailing Address - Phone:772-567-6181
Mailing Address - Fax:772-567-8242
Practice Address - Street 1:2215 NEBRASKA AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4864
Practice Address - Country:US
Practice Address - Phone:772-567-6181
Practice Address - Fax:772-567-8242
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME103412207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology