Provider Demographics
NPI:1750672523
Name:ZADEH, JOSEPH HASSAN (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HASSAN
Last Name:ZADEH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 S MAIN ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7514
Mailing Address - Country:US
Mailing Address - Phone:817-937-5406
Mailing Address - Fax:
Practice Address - Street 1:1340 S MAIN ST
Practice Address - Street 2:SUITE 180
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7514
Practice Address - Country:US
Practice Address - Phone:817-937-5406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F60967Medicare UPIN