Provider Demographics
NPI:1205832524
Name:TADVICK, JOSEPH LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEONARD
Last Name:TADVICK
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 1:1904 PINE ST
Mailing Address - Street 2:STE 4A
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2450
Mailing Address - Country:US
Mailing Address - Phone:325-437-4020
Mailing Address - Fax:325-437-4029
Practice Address - Street 1:1801 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2333
Practice Address - Country:US
Practice Address - Phone:325-670-4020
Practice Address - Fax:325-670-4029
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5712174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142674401Medicaid
TX00105QMedicare ID - Type Unspecified
TX142674401Medicaid