Provider Demographics
NPI:1538462155
Name:JOSEPH, HIDLY MOREAU (SA-C)
Entity Type:Individual
Prefix:MRS
First Name:HIDLY
Middle Name:MOREAU
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2911 WALNUT SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-6208
Mailing Address - Country:US
Mailing Address - Phone:281-433-3668
Mailing Address - Fax:
Practice Address - Street 1:10039 BISSONNET ST STE 250
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7852
Practice Address - Country:US
Practice Address - Phone:713-779-9800
Practice Address - Fax:713-779-9813
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10-148363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical