Provider Demographics
NPI:1770586331
Name:SHOTWELL, JOYCE M (MD)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:M
Last Name:SHOTWELL
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 1:3801 GASTON AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1541
Mailing Address - Country:US
Mailing Address - Phone:214-824-4412
Mailing Address - Fax:214-824-4431
Practice Address - Street 1:3801 GASTON AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1541
Practice Address - Country:US
Practice Address - Phone:214-824-4412
Practice Address - Fax:214-824-4431
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4525174400000X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120108905Medicaid
TX0069EYOtherBCBS
8D3230Medicare ID - Type Unspecified
TX0069EYOtherBCBS