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General NPI Number Information
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NPI Number | 1134574007
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Entity Type | Individual
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Provider Name | JOSEPH RADZEVICH D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 431 E STATE HIGHWAY 114 STE 450
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City | SOUTHLAKE
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State | TX
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Zip | 76092-4417
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Country | US
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Telephone | 817-912-1610
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Fax | 817-912-1611
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Provider Business Mailing Address
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Address Line | 431 E STATE HIGHWAY 114 STE 450
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City | SOUTHLAKE
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State | TX
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Zip | 76092-4417
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Country | US
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Telephone | 817-912-1610
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Fax | 817-912-1611
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2023016051
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | W0086
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License Number State | TX
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