Provider Demographics
NPI:1679692040
Name:JOSEPH M DEFELICE MD PA
Entity type:Organization
Organization Name:JOSEPH M DEFELICE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEFELICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-446-3302
Mailing Address - Street 1:303 PINELLAS ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3809
Mailing Address - Country:US
Mailing Address - Phone:727-446-3302
Mailing Address - Fax:727-442-9706
Practice Address - Street 1:303 PINELLAS ST
Practice Address - Street 2:SUITE 320
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3809
Practice Address - Country:US
Practice Address - Phone:727-446-3302
Practice Address - Fax:727-442-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055250207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD82214Medicare UPIN
FL08808Medicare ID - Type UnspecifiedPROVIDER ID