NPIMap

Organization Active NPI

Joseph Park, D.O., PLLC

  • Family Medicine Physician
  • The Colony, TX
National Provider Identifier
1649427337
Registry record updated Aug 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L6563 Issued in TX
Legal business name
JOSEPH PARK, D.O., PLLC
Practice address
3805 Main St
Ste 112
The Colony, TX 75056-2852
Phone
(972) 370-0004
Fax
(972) 370-0088
NPI assigned
Aug 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joseph ParkNPI 1891848412
Title
Owner
Phone
(972) 370-0004

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X L6563 TX Primary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X M5418 TX

Addresses

Primary practice location

3805 Main St
Ste 112
The Colony, TX 75056-2852

Mailing address

3805 Main St
Ste 112
The Colony, TX 75056-2852
Phone (972) 370-0004

Other identifiers 1

IdentifierTypeStateIssuer
1675746-02MedicaidTX

National Provider Directory

National Provider Directory

Locations

3805 Main St
Ste 112
The Colony, TX 75056
Phone (972) 370-0004

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377648000000",
    "number": "1649427337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3805 MAIN ST",
            "address_2": "STE 112",
            "city": "THE COLONY",
            "state": "TX",
            "postal_code": "750562852",
            "telephone_number": "972-370-0004",
            "fax_number": "972-370-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 MAIN ST",
            "address_2": "STE 112",
            "city": "THE COLONY",
            "state": "TX",
            "postal_code": "750562852",
            "telephone_number": "972-370-0004",
            "fax_number": "972-370-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH PARK, D.O., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-25",
        "last_updated": "2013-08-28",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-370-0004"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "L6563",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "M5418",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1675746-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in The Colony, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.