Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 111064 | AK |
N | 207Q00000X | Family Doctor | 111064 | AK |
NPI | 1649618059 |
---|---|
Provider Name | Mary J Joy |
First Address | Fairbanks, AK 99701-4948 |
Second Address | Fairbanks, AK 99701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2013 |
Last Update Date | 06/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1652171 | (05) | AK |