Provider Demographics
NPI:1700965092
Name:EMBRY, JOSHUA PAUL (PAC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:PAUL
Last Name:EMBRY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MEDICAL PKWY
Mailing Address - Street 2:BUILDING B, SUITE 300
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7763
Mailing Address - Country:US
Mailing Address - Phone:512-260-5860
Mailing Address - Fax:512-260-5859
Practice Address - Street 1:1401 MEDICAL PKWY
Practice Address - Street 2:BUILDING B, SUITE 300
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7763
Practice Address - Country:US
Practice Address - Phone:512-260-5860
Practice Address - Fax:512-260-5859
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J3807Medicare PIN
TX322496YTH1Medicare UPIN
TX322496YTH1Medicare UPIN