Provider Demographics
NPI:1124185970
Name:JOE, GENE DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:DAVID
Last Name:JOE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9101
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9494
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:972-745-4336
Practice Address - Street 1:5405 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-6148
Practice Address - Country:US
Practice Address - Phone:817-465-4928
Practice Address - Fax:817-472-0758
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197236603Medicaid
TX197236601Medicaid
TX197236601Medicaid
TX8L3617Medicare PIN