Provider Demographics
NPI:1902848914
Name:JOYCE, PETER W (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:W
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:DEPT LA 21559
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-1559
Mailing Address - Country:US
Mailing Address - Phone:323-297-0670
Mailing Address - Fax:
Practice Address - Street 1:2202 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5706
Practice Address - Country:US
Practice Address - Phone:310-264-9000
Practice Address - Fax:310-264-9004
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG272232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G272230OtherBLUE SHIELD OF CA
CA00G272230Medicaid
CAWG27223RMedicare PIN
AT959ZMedicare PIN
CA00G272230Medicaid
A43279Medicare UPIN
CA00G272230OtherBLUE SHIELD OF CA
CA300062588Medicare PIN
CAWG27223DMedicare PIN
CAWG27223PMedicare PIN