Provider Demographics
NPI:1699034728
Name:DACUS, JOEL BRUCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:BRUCE
Last Name:DACUS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-0834
Mailing Address - Country:US
Mailing Address - Phone:214-404-9376
Mailing Address - Fax:
Practice Address - Street 1:4444 HERITAGE TRACE PKWY STE 400
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8944
Practice Address - Country:US
Practice Address - Phone:817-424-3668
Practice Address - Fax:817-741-4001
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2003213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine