Individual
DR. DOMINIC MALIAKKAL JOSEPH
Active
Individual
DR. DOMINIC MALIAKKAL JOSEPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MDPA
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
J1278
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131226604
—
TX
05
—
131226605
—
TX
05
—
131226606
—
TX
01
—
260044914
RAIL ROAD
TX
01
—
260044915
RAIL ROAD
TX
01
—
89406S
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/20/2006
Last updated
10/19/2020
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