Provider Demographics
NPI:1144339862
Name:LANESE, JOSEPH W (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:LANESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 WEBB RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2872
Mailing Address - Country:US
Mailing Address - Phone:813-884-7971
Mailing Address - Fax:813-249-0794
Practice Address - Street 1:6101 WEBB RD
Practice Address - Street 2:SUITE 107
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2872
Practice Address - Country:US
Practice Address - Phone:813-884-7971
Practice Address - Fax:813-249-0794
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059249207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF71270Medicare UPIN
FL23658AMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID