Provider Demographics
NPI:1013934801
Name:TOULOUSE, JOSEPH C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:TOULOUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 N ORANGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-7917
Mailing Address - Country:US
Mailing Address - Phone:863-257-3936
Mailing Address - Fax:
Practice Address - Street 1:2435 N AZALEA DR
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9516
Practice Address - Country:US
Practice Address - Phone:863-257-3963
Practice Address - Fax:863-354-6616
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33082207P00000X
CAC 5613207P00000X
FLME82481207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME82481OtherMEDICAL LICENSE NUMBER
FL261707200Medicaid
IA14212Medicare ID - Type UnspecifiedOLD - LAPSED
FLH08775Medicare UPIN
IAH08775Medicare UPIN
FL261707200Medicaid
FLE5904Medicare ID - Type Unspecified