Provider Demographics
NPI:1598750614
Name:ROBERTS, JOYCE A (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:A
Other - Last Name:GAMMILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-9347
Mailing Address - Country:US
Mailing Address - Phone:575-356-6652
Mailing Address - Fax:575-226-0099
Practice Address - Street 1:42121 US HWY 70
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-9347
Practice Address - Country:US
Practice Address - Phone:575-356-6652
Practice Address - Fax:575-226-0099
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM87277207Q00000X
TXG8379207Q00000X
NM87-277207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39857Medicaid
NM130914807Medicaid
E09169Medicare UPIN
341430113Medicare ID - Type Unspecified
NM39857Medicaid