Provider Demographics
NPI:1568821486
Name:JOSEY, IMAN
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:
Last Name:JOSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5245
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78683-5245
Mailing Address - Country:US
Mailing Address - Phone:512-210-6888
Mailing Address - Fax:888-665-0906
Practice Address - Street 1:121 RIVER BEND DR
Practice Address - Street 2:19104
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3368
Practice Address - Country:US
Practice Address - Phone:512-210-6888
Practice Address - Fax:888-665-0906
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802388923171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor