Provider Demographics
NPI:1649252925
Name:SIRACUSE, JOAN E (MD)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:E
Last Name:SIRACUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-4936
Mailing Address - Country:US
Mailing Address - Phone:863-385-4300
Mailing Address - Fax:863-386-1358
Practice Address - Street 1:2237 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-4936
Practice Address - Country:US
Practice Address - Phone:863-385-4300
Practice Address - Fax:863-386-1358
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54536207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892750860OtherCLINICIAN PROVIDER NUMBER
FL99112405OtherHIRSP PROVIDER NUMBER
FL202003321-00OtherBETTER WORKERS COMPENSATION
FL051624400Medicaid
FL07777OtherBCBS OF FLORIDA
FLP00176778OtherRAILROAD MEDICARE
FLN178075OtherWELLCARE PROVIDER ID
FL99112405OtherHIRSP PROVIDER NUMBER
FL051624400Medicaid
FL07777XMedicare PIN