Provider Demographics
NPI:1578507380
Name:GIROUARD, JONIE MYRSTOL (MD)
Entity Type:Individual
Prefix:DR
First Name:JONIE
Middle Name:MYRSTOL
Last Name:GIROUARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JONIE
Other - Middle Name:MYRSTOL
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15806 BROOKWAY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3237
Mailing Address - Country:US
Mailing Address - Phone:704-766-1000
Mailing Address - Fax:704-766-1002
Practice Address - Street 1:15806 BROOKWAY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078
Practice Address - Country:US
Practice Address - Phone:704-766-1000
Practice Address - Fax:704-766-1002
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2210052Medicaid
WY314566OtherBCBS PIN
MT0157386OtherMDCD PIN
WY123496000OtherMDCD PIN
H07284Medicare UPIN
MT2210052Medicaid
WY314566OtherBCBS PIN
MT270074Medicare ID - Type Unspecified
MTW21621Medicare PIN