Provider Demographics
NPI:1609189257
Name:SMALLEY, JOSHUA M (DO)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:M
Last Name:SMALLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59TH MEDICAL WING
Mailing Address - Street 2:1100 WILFORD HALL LOOP
Mailing Address - City:JBSA LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236
Mailing Address - Country:US
Mailing Address - Phone:210-292-3725
Mailing Address - Fax:
Practice Address - Street 1:3100 SCHOFIELD RD
Practice Address - Street 2:BLDG 1179
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-7577
Practice Address - Country:US
Practice Address - Phone:210-916-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A 122642080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program