Provider Demographics
NPI:1033115167
Name:PATRICK, JOSEPH JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAMES
Last Name:PATRICK
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 1:1728 BISSONNET ST
Mailing Address - Street 2:STE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1710
Mailing Address - Country:US
Mailing Address - Phone:713-520-8522
Mailing Address - Fax:713-520-8541
Practice Address - Street 1:1728 BISSONNET ST
Practice Address - Street 2:STE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1710
Practice Address - Country:US
Practice Address - Phone:713-520-8522
Practice Address - Fax:713-520-8541
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7864174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC20288Medicare UPIN
TXOOGM420Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER