Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 6005 | OK |
N | 207Q00000X | Family Doctor | 280771 | NY |
Y | 207QA0505X | Family Doctor - Adult Medicine | 6005 | OK |
NPI | 1639592181 |
---|---|
Provider Name | Dr. Justin P Joseph |
First Address | Oklahoma City, OK 73120-2828 |
Second Address | Oklahoma City, OK 73112-2179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2014 |
Last Update Date | 20/10/2020 |