Provider Demographics
NPI:1740379304
Name:JOE, BRIAN LEE (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
Last Name:JOE
Suffix:
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 1:997 RAINTREE CIRCLE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:972-359-7911
Mailing Address - Fax:972-359-7917
Practice Address - Street 1:997 RAINTREE CIRCLE
Practice Address - Street 2:SUITE 160
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:972-359-7911
Practice Address - Fax:972-359-7917
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL80882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI05582Medicare UPIN