Organization
JOSEPH R AGOSTINELLI DPM PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH R AGOSTINELLI DPM (PHYSICIAN)
(850) 863-2153
Entity
Organization
Contact information
Practice address
1034 MAR WALT DR STE 100, FORT WALTON BEACH, FL 32547-6645
(850) 863-2153
(850) 315-9350
Mailing address
1034 MAR WALT DR STE 100, FORT WALTON BEACH, FL 32547-6645
(850) 863-2153
(850) 315-9350
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO0002643
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340506100
—
FL
01
—
65837
BS PROVIDER NUMBER
FL
Enumeration date
02/13/2007
Last updated
05/30/2008
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