Provider Demographics
NPI:1578850145
Name:JOSEPH S. WASSEF, M.D., P.C.
Entity Type:Organization
Organization Name:JOSEPH S. WASSEF, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PYSCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SOLIMAN
Authorized Official - Last Name:WASSEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-504-5459
Mailing Address - Street 1:2010 SYBIL LN STE 150
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1830
Mailing Address - Country:US
Mailing Address - Phone:903-504-5459
Mailing Address - Fax:903-504-5460
Practice Address - Street 1:2010 SYBIL LN STE 150
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1830
Practice Address - Country:US
Practice Address - Phone:903-504-5459
Practice Address - Fax:903-504-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X
TXJ2468282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
061730OtherVALUE OPTIONS
TX5295014OtherAETNA
00T73HOtherBLUE CROSS AND BLUE SHIELD
TX5295014OtherAETNA
00T73HOtherBLUE CROSS AND BLUE SHIELD
TX00T73HMedicare PIN