Provider Demographics
NPI:1164579983
Name:JOSEPH, ANTONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTONY
Middle Name:
Last Name:JOSEPH
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 1:11311 BRIDGEPORT WAY SW STE 309
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3078
Mailing Address - Country:US
Mailing Address - Phone:253-985-2733
Mailing Address - Fax:253-985-2868
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 309
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3078
Practice Address - Country:US
Practice Address - Phone:253-985-2733
Practice Address - Fax:253-985-2868
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23368208600000X
MO2013022998208600000X
WAMD61313407208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR202265001Medicaid
WA2217795Medicaid
MO1164579983Medicaid