Provider Demographics
NPI:1841308244
Name:NEUBAUER, JOSEPH BERNARD (DPM)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BERNARD
Last Name:NEUBAUER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 WILTSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1085
Mailing Address - Country:US
Mailing Address - Phone:615-430-1063
Mailing Address - Fax:
Practice Address - Street 1:1719 WILTSHIRE DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1085
Practice Address - Country:US
Practice Address - Phone:615-430-1063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN544213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3353130Medicaid
TN3353130Medicare ID - Type Unspecified
TNU78162Medicare UPIN
TN3353130Medicaid