Provider Demographics
NPI:1639461742
Name:PARUOLO, JOSEPH BLACKWELL (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BLACKWELL
Last Name:PARUOLO
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 1:701 94TH AVE N STE 250
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2448
Mailing Address - Country:US
Mailing Address - Phone:727-321-3854
Mailing Address - Fax:727-327-7670
Practice Address - Street 1:302 BRYAN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5337
Practice Address - Country:US
Practice Address - Phone:727-321-3854
Practice Address - Fax:727-327-7670
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-07
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125265207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016931900Medicaid
FLHYMVKOtherBCBS
FLHYMVKOtherBCBS