Provider Demographics
NPI:1649575945
Name:PERMENTER, JOSEPH (RCIS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:PERMENTER
Suffix:
Gender:M
Credentials:RCIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8470 KINGBIRD LOOP
Mailing Address - Street 2:UNIT 1013
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5769
Mailing Address - Country:US
Mailing Address - Phone:239-537-2958
Mailing Address - Fax:
Practice Address - Street 1:8470 KINGBIRD LOOP
Practice Address - Street 2:UNIT 1013
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-5769
Practice Address - Country:US
Practice Address - Phone:239-537-2958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00061270246XC2901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive Specialist