Provider Demographics
NPI:1912913484
Name:OOLUT, JOSEPH J (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:OOLUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 PARK GROVE LN SUITE 310
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1088
Mailing Address - Country:US
Mailing Address - Phone:713-464-9100
Mailing Address - Fax:713-468-6183
Practice Address - Street 1:411 PARK GROVE DR STE 310
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1580
Practice Address - Country:US
Practice Address - Phone:281-579-5799
Practice Address - Fax:281-579-5798
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4410174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181612605Medicaid
TX8GF316OtherBCBS
TX8G7263Medicare PIN
TX8M8498OtherBCBSTX
TXP00631602Medicare PIN