Provider Demographics
NPI:1942254768
Name:JOSHUA, GRACY (MD)
Entity Type:Individual
Prefix:
First Name:GRACY
Middle Name:
Last Name:JOSHUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 LAKE WORTH RD
Mailing Address - Street 2:#204 MEDICAL SPECIALISTS OF THE PALM BEACHES
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463
Mailing Address - Country:US
Mailing Address - Phone:561-968-7968
Mailing Address - Fax:561-964-4603
Practice Address - Street 1:3918 VIA POINCIANA
Practice Address - Street 2:#1
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2991
Practice Address - Country:US
Practice Address - Phone:561-439-4682
Practice Address - Fax:561-968-0483
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME39021207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61247Medicare PIN
B98683Medicare UPIN