Provider Demographics
NPI:1952317026
Name:JOE, VINCENT Q (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:Q
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 1:3015 N BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131
Mailing Address - Country:US
Mailing Address - Phone:314-996-5157
Mailing Address - Fax:314-996-4398
Practice Address - Street 1:3015 N BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2329
Practice Address - Country:US
Practice Address - Phone:314-996-5157
Practice Address - Fax:314-996-4398
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361094652085R0001X, 2085R0202X
MO20001570042085R0202X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
143115OtherBLUE CHOICE
431725842MIDOtherMERCY
IL0361094651Medicaid
1390OtherMO BLUE
468378OtherHLINK
2400026OtherPH PLAN
2781OtherGHP
46055OtherHCARE USA
920006052OtherRR MEDICARE
MO205073109Medicaid
2400026OtherPH PLAN
920006052OtherRR MEDICARE
IL0361094651Medicaid