=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013112119
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH PATRICK MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2007
-----------------------------------------------------
Last Update Date | 03/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2569 DOUGLASS AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38114-2532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-271-6200
-----------------------------------------------------
Fax | 901-271-6249
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2595 CENTRAL AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38104-5905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-260-8551
-----------------------------------------------------
Fax | 901-260-8590
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 47085
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | LL29777
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------