Provider Demographics
NPI:1932390127
Name:SRESHTA, JOSEPH NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:NICHOLAS
Last Name:SRESHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J. NICHOLAS
Other - Middle Name:
Other - Last Name:SRESHTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:
Practice Address - Street 1:450 BLOSSOM ST
Practice Address - Street 2:SUITE C
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4228
Practice Address - Country:US
Practice Address - Phone:281-338-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0029117208800000X
TXP5733208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX327010001Medicaid
TX327010002Medicaid
TXP01271123OtherRAILROAD MEDICARE
4641183995OtherMYUTMB 4641183995
TX295416YS8QMedicare PIN
TX327010002Medicaid