Provider Demographics
NPI:1306341367
Name:LACKEY, JOSHUA TAYLOR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:TAYLOR
Last Name:LACKEY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:11615 ANGUS RD STE 106
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4064
Mailing Address - Country:US
Mailing Address - Phone:254-466-4210
Mailing Address - Fax:
Practice Address - Street 1:11615 ANGUS RD STE 106
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4064
Practice Address - Country:US
Practice Address - Phone:512-436-9986
Practice Address - Fax:512-436-8295
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV0787207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery