Provider Demographics
NPI:1386739811
Name:MOAKE, JOE L (MD)
Entity type:Individual
Prefix:PROF
First Name:JOE
Middle Name:L
Last Name:MOAKE
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 1:1709 DRYDEN
Mailing Address - Street 2:SUITE 675
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-798-2250
Mailing Address - Fax:713-798-2255
Practice Address - Street 1:1709 DRYDEN
Practice Address - Street 2:SUITE 675
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-798-2250
Practice Address - Fax:713-798-2255
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0560207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE0560OtherMEDICAL LICENSE
TXF0056163OtherDPS
AM2651986OtherDEA LICENSE
FU63Medicare ID - Type Unspecified
TXF0056163OtherDPS