Healthcare Provider Details

I. General information

NPI: 1992905814
Provider Name (Legal Business Name): JOSEPH STANLEY RESTIVO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 S I 35 E
DENTON TX
76210-6850
US

IV. Provider business mailing address

PO BOX 745390
ATLANTA GA
30374-5390
US

V. Phone/Fax

Practice location:
  • Phone: 940-384-3810
  • Fax: 940-565-9588
Mailing address:
  • Phone: 940-384-3810
  • Fax: 940-565-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberU0266
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number05-35295
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: