Healthcare Provider Details

I. General information

NPI: 1316470461
Provider Name (Legal Business Name): JOSEPH AGYEN JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 GASTON AVE STE 330
DALLAS TX
75246-1500
US

IV. Provider business mailing address

3801 GASTON AVE STE 330
DALLAS TX
75246-1500
US

V. Phone/Fax

Practice location:
  • Phone: 214-824-3851
  • Fax: 214-824-3852
Mailing address:
  • Phone: 214-824-3851
  • Fax: 214-824-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number3055
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: