Provider Demographics
NPI:1760478630
Name:JOYCE, CHARLES B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:B
Last Name:JOYCE
Suffix:JR
Gender:M
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:PO BOX 14474
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71207-4474
Mailing Address - Country:US
Mailing Address - Phone:318-325-5435
Mailing Address - Fax:318-325-8852
Practice Address - Street 1:1908 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5724
Practice Address - Country:US
Practice Address - Phone:318-325-5435
Practice Address - Fax:318-325-8852
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20142207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1967254Medicaid
H25003OtherVANTAGE
5R631Medicare ID - Type Unspecified
LA1967254Medicaid