Provider Demographics
NPI:1639460801
Name:WORLEY, JOSHUA TYSON (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:TYSON
Last Name:WORLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:502 N VALLEY PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3437
Mailing Address - Country:US
Mailing Address - Phone:972-316-0902
Mailing Address - Fax:972-316-1161
Practice Address - Street 1:714 N HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4510
Practice Address - Country:US
Practice Address - Phone:972-316-0902
Practice Address - Fax:972-316-1161
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM.200043213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery