Provider Demographics
NPI:1740474725
Name:PERSON, JOSEPH JR (LMP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:PERSON
Suffix:JR
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 N ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4811
Mailing Address - Country:US
Mailing Address - Phone:509-327-8306
Mailing Address - Fax:
Practice Address - Street 1:8517 N COLTON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5804
Practice Address - Country:US
Practice Address - Phone:509-465-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020947174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist