Individual
DR. JOSHUA DIVINEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 606-4262
Mailing address
PO BOX 846098, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
BP10050377
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
362954508
—
TX
05
—
362954509
—
TX
01
—
533082YS6P
MEDICARE
TX
01
—
533082YS6V
MEDICARE
TX
01
—
75-0818167-015
TRICARE
TX
01
—
75-0818167-044
TRICARE
TX
01
—
75-0818167-048
TRICARE
TX
01
—
75-0818167-051
TRICARE
TX
01
—
75-1976930-005
TRICARE
TX
01
—
8GY855
BCBS
TX
01
—
P01876972
MEDICARE RAIL ROAD
TX
01
—
P01877172
MEDICARE RAIL ROAD
TX
Enumeration date
05/05/2014
Last updated
11/20/2017
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