Provider Demographics
NPI:1548466519
Name:RAVID, JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:RAVID
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 1:21942 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9723
Mailing Address - Country:US
Mailing Address - Phone:941-505-2100
Mailing Address - Fax:941-505-6100
Practice Address - Street 1:21942 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9723
Practice Address - Country:US
Practice Address - Phone:941-505-2100
Practice Address - Fax:941-505-6100
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 106244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3121YOtherMEDICARE INDIVIDUAL
FL14C4QOtherBC/BS
FLP01037543OtherRR MEDICARE
FLP01037543OtherRR MEDICARE