Healthcare Provider Details

I. General information

NPI: 1366183972
Provider Name (Legal Business Name): JOSEPH AARON QUEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6435 W JEFFERSON BLVD # 434
FORT WAYNE IN
46804-6203
US

IV. Provider business mailing address

PO BOX 843603
DALLAS TX
75284-0001
US

V. Phone/Fax

Practice location:
  • Phone: 260-436-7875
  • Fax: 260-432-9812
Mailing address:
  • Phone: 972-233-1999
  • Fax: 972-233-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01100315A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301513105
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: