Provider Demographics
NPI:1144424821
Name:JOICE, JASON CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CHARLES
Last Name:JOICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 NE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-8850
Mailing Address - Country:US
Mailing Address - Phone:918-824-6407
Mailing Address - Fax:918-824-6408
Practice Address - Street 1:1301 NE 1ST ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-8850
Practice Address - Country:US
Practice Address - Phone:918-824-6407
Practice Address - Fax:918-824-6408
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23052207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDE3229OtherGROUP RR MEDICARE
OK200209580AMedicaid
OKP00807082OtherRR MEDICARE
OK200039950AMedicaid
500522114Medicare PIN
OK401527Medicare PIN