Individual
JOEL MICAH SUPPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSFA, CST
Contact information
Practice address
809 SILVERTON ST, SOUTHLAKE, TX 76092-3854
(214) 227-2457
(214) 764-0880
Mailing address
PO BOX 938, ROWLETT, TX 75030-0938
(214) 227-2457
(214) 764-0880
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
202123
TX
Other
Enumeration date
06/11/2021
Last updated
12/20/2025
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