MEDICARE: MR. TIMOTHY JOSHUA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver

General Provider Information

NPI Number	:	1760041446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY JOSHUA

Provider Business Mailing Address
First Line	:	3919 ESSEX LN APT 214
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5143
Country	:	US
Telephone Number	:	281-804-1286
Fax Number	:

Provider Business Practice Location Address
First Line	:	3919 ESSEX LN APT 214
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5143
Country	:	US
Telephone Number	:	281-804-1286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2019
Last Update Date	:	06/06/2019

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