Provider Demographics
NPI:1679736193
Name:BRANCHIK, JOSELYN JEDICK (DO)
Entity Type:Individual
Prefix:
First Name:JOSELYN
Middle Name:JEDICK
Last Name:BRANCHIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JOSELYN
Other - Middle Name:MARIE
Other - Last Name:JEDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 3630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-3630
Mailing Address - Country:US
Mailing Address - Phone:928-522-9879
Mailing Address - Fax:928-522-9880
Practice Address - Street 1:2090 SMOKETREE AVE N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5806
Practice Address - Country:US
Practice Address - Phone:928-854-1800
Practice Address - Fax:928-854-1847
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR70138207Q00000X
AZ005490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine