Provider Demographics
NPI:1992785745
Name:HOUK, JOSEPH A (PA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:HOUK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 N BLACK CANYON HWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4757
Mailing Address - Country:US
Mailing Address - Phone:602-942-4464
Mailing Address - Fax:
Practice Address - Street 1:1840 S STAPLEY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6681
Practice Address - Country:US
Practice Address - Phone:480-464-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ170803Medicaid
AZ170803Medicaid
AZS55977Medicare UPIN