Provider Demographics
NPI:1942420419
Name:JOSEPH, MOISE (MD)
Entity type:Individual
Prefix:
First Name:MOISE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530077
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4225 W GLENDALE AVE
Practice Address - Street 2:E119
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8194
Practice Address - Country:US
Practice Address - Phone:623-915-0270
Practice Address - Fax:623-915-4837
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA587932084P0800X
AZ335172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG09903Medicare UPIN
AZ106169Medicare ID - Type Unspecified