Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 13669 | MA |
NPI | 1083689202 |
---|---|
Provider Name | Dr. Lawrence William Joyce |
First Address | Medford, MA 02155 |
Second Address | Medford, MA 02155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16170 | HARVARD (01) | |
704304 | AETNA US HEALTHCARE (01) | |
X04304 | (02) |