Provider Demographics
NPI:1316966575
Name:SEDRAK, JOSEPH FAYEZ (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FAYEZ
Last Name:SEDRAK
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 1:3609 BUSINESS CENTER DR STE 124
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4168
Mailing Address - Country:US
Mailing Address - Phone:346-888-4400
Mailing Address - Fax:346-888-4401
Practice Address - Street 1:4101 GREENBRIAR DR STE 305
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-5244
Practice Address - Country:US
Practice Address - Phone:346-888-4400
Practice Address - Fax:346-888-4401
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84538207N00000X, 207ND0101X, 207NS0135X
TXN0447207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CD058OtherBCBS OF TEXAS
TX8CD058OtherBCBS OF TEXAS
TX8F22949Medicare PIN
CA00A845380Medicare PIN