Provider Demographics
NPI:1689068025
Name:MOORE, JOYCE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOYCE
Other - Middle Name:MCCAUGHAN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:305 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1827
Mailing Address - Country:US
Mailing Address - Phone:269-983-3973
Mailing Address - Fax:
Practice Address - Street 1:305 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1827
Practice Address - Country:US
Practice Address - Phone:269-983-3973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046547A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MCO422852Medicare PIN