Provider Demographics
NPI:1649618059
Name:JOY, MARY J (DO)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:JOY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4948
Mailing Address - Country:US
Mailing Address - Phone:907-459-3500
Mailing Address - Fax:907-459-3526
Practice Address - Street 1:1001 NOBLE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-459-3500
Practice Address - Fax:907-459-3526
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK111064207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1652171Medicaid
AKK168032Medicare PIN