Provider Demographics
NPI:1891785820
Name:JOYCE, MATTHEW H (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:H
Last Name:JOYCE
Suffix:
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 44619
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711
Mailing Address - Country:US
Mailing Address - Phone:208-321-4609
Mailing Address - Fax:208-884-3975
Practice Address - Street 1:520 S EAGLE ROAD
Practice Address - Street 2:SUITE 1200
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-321-4609
Practice Address - Fax:208-884-3975
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7864208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805495400Medicaid
ID807645700OtherHEALTHY CONNECTIONS
ID807645700OtherHEALTHY CONNECTIONS