Individual
DR. JOEL R UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-4500
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
E-4888
AR
207L00000X
Anesthesiology Physician
Primary
MED-PHYS-LIC-82373
MT
207L00000X
Anesthesiology Physician
P4721
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
309898001
—
TX
01
—
75-2616977-042
TRICARE
TX
01
—
8DM214
BCBS
TX
01
—
P01118428
RAIL ROAD
TX
Enumeration date
08/15/2006
Last updated
05/26/2020
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