Provider Demographics
NPI:1679867709
Name:FUNCHES, JOSALYN CAMILLE (MD)
Entity Type:Individual
Prefix:MS
First Name:JOSALYN
Middle Name:CAMILLE
Last Name:FUNCHES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 W CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8193
Mailing Address - Country:US
Mailing Address - Phone:800-233-3264
Mailing Address - Fax:480-821-4371
Practice Address - Street 1:1717 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-8193
Practice Address - Country:US
Practice Address - Phone:800-233-3264
Practice Address - Fax:480-821-4371
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00893207Q00000X
NC173043207Q00000X
AZ57135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ473973Medicaid