Provider Demographics
NPI:1841372737
Name:RICHARDS, JOYCE LYNN (DO)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:LYNN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:PAYER CREDENTIALING
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3118
Mailing Address - Country:US
Mailing Address - Phone:928-773-2559
Mailing Address - Fax:928-213-6292
Practice Address - Street 1:294 W STATE ROUTE 89A
Practice Address - Street 2:SUITE 213
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3754
Practice Address - Country:US
Practice Address - Phone:928-649-7913
Practice Address - Fax:928-649-7914
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2091207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ321612Medicaid
AZZ120051Medicare PIN
AZ321612Medicaid