Provider Demographics
NPI:1689670739
Name:AUTRY, JOSEPH H III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:H
Last Name:AUTRY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 CONNECTICUT AVE NW
Mailing Address - Street 2:STE 215
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-1845
Mailing Address - Country:US
Mailing Address - Phone:202-966-2085
Mailing Address - Fax:
Practice Address - Street 1:5225 CONNECTICUT AVE NW
Practice Address - Street 2:STE 215
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1845
Practice Address - Country:US
Practice Address - Phone:202-966-2085
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD25558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCAU033089Medicare UPIN