Healthcare Provider Details

I. General information

NPI: 1043233687
Provider Name (Legal Business Name): JOSEPH SOLIMAN WASSEF M.D., P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 SYBIL LN STE 150
TYLER TX
75703-1830
US

IV. Provider business mailing address

2010 SYBIL LN STE 150
TYLER TX
75703-1830
US

V. Phone/Fax

Practice location:
  • Phone: 903-504-5459
  • Fax: 903-504-5460
Mailing address:
  • Phone: 903-504-5459
  • Fax: 903-504-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberJ2468
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberJ2468
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: