Provider Demographics
NPI:1467566612
Name:HLAVIN, JOSEPH (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:HLAVIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 UNIVERSITY DR E
Mailing Address - Street 2:STE 410
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3475
Mailing Address - Country:US
Mailing Address - Phone:979-776-8896
Mailing Address - Fax:979-774-0716
Practice Address - Street 1:3201 UNIVERSITY DR E
Practice Address - Street 2:STE 410
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3475
Practice Address - Country:US
Practice Address - Phone:979-776-8896
Practice Address - Fax:979-774-0716
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04576363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00297133OtherMEDICARE RAILROAD
TX8N9622OtherBLUE CROSS PROVIDER NUMBE
TXP00297133OtherMEDICARE RAILROAD
TX8F1714Medicare PIN