Provider Demographics
NPI:1235107277
Name:JOSEPH, PHILMORE JOSLEY
Entity Type:Individual
Prefix:
First Name:PHILMORE
Middle Name:JOSLEY
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26912 MERLOT RIVER DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1448
Mailing Address - Country:US
Mailing Address - Phone:281-354-1234
Mailing Address - Fax:281-354-2514
Practice Address - Street 1:26912 MERLOT RIVER DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1448
Practice Address - Country:US
Practice Address - Phone:281-354-1234
Practice Address - Fax:281-354-2514
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE 1210207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115759601Medicaid
TX115759601Medicaid
TXOOQM11Medicare ID - Type Unspecified