Doctor Name: | DR. JOSEPH FREDERIC SACKETT |
NPI Number: | 1720486111 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 18916-20 |
Business Practice Address: | 611 Ponte Vedra Blvd Unit 122 Ponte Vedra Beach, FL - 32082 |
Business Phone Number: | 9042804388 |
Business Fax Number: | 9042800807 |
Mailing Address: | 611 Ponte Vedra Blvd, Unit 122 PONTE VEDRA BEACH |
State: | FL |
Postal Code: | 32082 |
Phone Number: | 9042804388 |
Fax Number: | 9042800807 |
NPI Enumeration Date: | 12/17/2014 |
NPI Last Update Date: | 12/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 18916-20 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |