Provider Demographics
NPI:1205864667
Name:JOSEPH, ROY M (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:M
Last Name:JOSEPH
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:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:3201 TEASLEY LN STE 202
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8304
Practice Address - Country:US
Practice Address - Phone:940-243-7200
Practice Address - Fax:940-565-1577
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3266207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0029CHOtherBC/BS
TX214637501Medicaid
TX029534701Medicaid
TX0A0272Medicare PIN
TX0029CHOtherBC/BS
TX029534701Medicaid
TX00084DMedicare PIN