Provider Demographics
NPI:1184667800
Name:MOAK, JOSEPH SAMUEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SAMUEL
Last Name:MOAK
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:P.O. BOX 24146
Mailing Address - Street 2:UNIVERSITY PHYSICIANS, PLLC
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-4146
Mailing Address - Country:US
Mailing Address - Phone:601-815-5047
Mailing Address - Fax:601-815-9596
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE DIV GENERAL INTERNAL MEDICINE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-03-05
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS08390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08775083Medicaid
MSD73494Medicare UPIN