Provider Demographics
NPI:1750475240
Name:VICKARYOUS, JOSEPH P (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:VICKARYOUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 BALD EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-2700
Mailing Address - Country:US
Mailing Address - Phone:239-393-2000
Mailing Address - Fax:239-393-0355
Practice Address - Street 1:531 BALD EAGLE DR
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-2700
Practice Address - Country:US
Practice Address - Phone:239-393-2000
Practice Address - Fax:239-393-0355
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9338207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine