Provider Demographics
NPI:1669639910
Name:JOSEPH, MARTIN K
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:K
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 BUTTERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6003
Mailing Address - Country:US
Mailing Address - Phone:469-733-7873
Mailing Address - Fax:
Practice Address - Street 1:350 OAKS TRL
Practice Address - Street 2:SUIE 201
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-8014
Practice Address - Country:US
Practice Address - Phone:469-733-7873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010638251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health