Basic Information
Provider Information
NPI: 1063632974
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEMKE
FirstName: JOSHUA
MiddleName: CHARLES
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5865
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794085865
CountryCode: US
TelephoneNumber: 8067432898
FaxNumber: 8067432787
Practice Location
Address1: 3601 4TH ST FL 4
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794300002
CountryCode: US
TelephoneNumber: 8067432373
FaxNumber: 8067434354
Other Information
ProviderEnumerationDate: 04/26/2007
LastUpdateDate: 12/02/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/02/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Y00000XN3609TXN Allopathic & Osteopathic PhysiciansOtolaryngology 
207YX0007XN3609TXN Allopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
207YX0905XN3609TXN Allopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
207YS0123XN3609TXY Allopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery

No ID Information.


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