Provider Demographics
NPI:1477518314
Name:PRINCE, JOSEPH EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:PRINCE
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 1:6409 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-4057
Mailing Address - Country:US
Mailing Address - Phone:409-935-2995
Mailing Address - Fax:409-935-3433
Practice Address - Street 1:6409 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-4057
Practice Address - Country:US
Practice Address - Phone:409-935-2995
Practice Address - Fax:409-935-3433
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9601207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101603205Medicaid
TX8R3391OtherBLUE CROSS ID
TX8C8596Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID