Provider Demographics
NPI:1588647739
Name:JOYCE, JACQUELINE K (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:JOYCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2317
Mailing Address - Country:US
Mailing Address - Phone:812-331-3405
Mailing Address - Fax:812-355-6538
Practice Address - Street 1:601 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403
Practice Address - Country:US
Practice Address - Phone:812-331-3405
Practice Address - Fax:812-355-6538
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049313A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200199640AMedicaid
IN000000338245OtherANTHEM BLUE CROSS BS
MI4654586Medicaid
IN200199640Medicaid
IN000000338245OtherANTHEM BLUE CROSS BS
IN200199640Medicaid
IN000000338245OtherANTHEM BLUE CROSS BS