Individual
JOSEPH SHALIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
194 E REDSTONE AVE STE B, CRESTVIEW, FL 32539-5368
(850) 682-1022
(850) 837-6481
Mailing address
PO BOX 160, CRESTVIEW, FL 32536-0160
(850) 650-6362
(850) 650-6362
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME67718
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26606
BCBS
FL
05
—
377542900
—
FL
01
—
593396174
TAX ID
FL
Enumeration date
07/04/2006
Last updated
07/08/2007
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