Provider Demographics
NPI:1912373663
Name:PEZAK, JOSEPH JR
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:PEZAK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 A1A BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6724
Mailing Address - Country:US
Mailing Address - Phone:904-460-0931
Mailing Address - Fax:904-460-0932
Practice Address - Street 1:1013 A1A BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6724
Practice Address - Country:US
Practice Address - Phone:904-460-0931
Practice Address - Fax:904-460-0932
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4229237700000X
PAF03244237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist