Provider Demographics
NPI:1063401271
Name:CHILDRESS, JOE R (MD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:R
Last Name:CHILDRESS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1210 ARION PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2880
Mailing Address - Country:US
Mailing Address - Phone:210-349-9300
Mailing Address - Fax:210-366-2558
Practice Address - Street 1:999 E BASSE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1801
Practice Address - Country:US
Practice Address - Phone:210-656-3040
Practice Address - Fax:210-656-6419
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2014-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE2513207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035640404Medicaid
TX8F21869Medicare PIN