Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D0901 | SD |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DD3715 | NM |
NPI | 1013179530 |
---|---|
Provider Name | Dr. Joyce Ann Jeffries |
First Address | Albuquerque, NM 87114-1580 |
Second Address | Albuquerque, NM 87114-1580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 04/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013179530 | (05) | SD |