Provider Demographics
NPI:1174916878
Name:STRAIT, JOSHUA SAMUEL (DO)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SAMUEL
Last Name:STRAIT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 MDG
Mailing Address - Street 2:UNIT 325
Mailing Address - City:RAMSTEIN AB
Mailing Address - State:APO AE
Mailing Address - Zip Code:09094
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86 MDG
Practice Address - Street 2:UNIT 3215
Practice Address - City:RAMSTEIN AB
Practice Address - State:APO AE
Practice Address - Zip Code:09094
Practice Address - Country:DE
Practice Address - Phone:314-479-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005579A2080P0006X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1174916878Medicaid
OR1174916878Medicaid