Individual
JOAN SYBELL PETALCORIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5615 DEAUVILLE STE 240, MIDLAND, TX 79706-2709
(432) 221-5560
(757) 963-6375
Mailing address
4214 ANDREWS HWY STE 240, MIDLAND, TX 79703-4817
(757) 963-6507
(757) 963-6375
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
0101246323
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005032249
MISSOURI TEMP LICENSE
MO
01
—
518857YPVD
TX MEDICARE-PREMIER
TX
01
—
6310
KANSAS TEMPORARY LICENSE
KS
Enumeration date
03/08/2007
Last updated
03/07/2023
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