Provider Demographics
NPI:1609189562
Name:CONDIE, JOY ALLISON (MD)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:ALLISON
Last Name:CONDIE
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 1:300 W CLARENDON AVE STE 375
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3476
Mailing Address - Country:US
Mailing Address - Phone:602-277-4161
Mailing Address - Fax:602-266-3481
Practice Address - Street 1:300 W CLARENDON AVE STE 375
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3476
Practice Address - Country:US
Practice Address - Phone:602-277-4161
Practice Address - Fax:602-266-3481
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1201742080N0001X
AZ452522080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine