Provider Demographics
NPI:1881615565
Name:JOSEPH, ANLY (MD)
Entity type:Individual
Prefix:
First Name:ANLY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 LOUIS HENNA BLVD # B
Practice Address - Street 2:SUITE 200
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7343
Practice Address - Country:US
Practice Address - Phone:512-255-9634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
13894OtherDEAN HEALTH PLAN
WI34619800Medicaid
390808509DMOtherUNITY
34619800OtherHIRSP
390808509OtherCIGNA
2012002OtherPHYSICIANS PLUS
TX8L24008Medicare UPIN
13894OtherDEAN HEALTH PLAN
I26256Medicare UPIN