Provider Demographics
NPI:1437405347
Name:JOSEPH, JEAN MANASSE (JEAN M JOSEPH)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MANASSE
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:JEAN M JOSEPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN ST STE JJL-310
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:281-448-6391
Mailing Address - Fax:281-260-3343
Practice Address - Street 1:6431 FANNIN ST STE JJL-310
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:281-448-6391
Practice Address - Fax:281-260-3343
Is Sole Proprietor?:No
Enumeration Date:2012-07-29
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6950207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine