Provider Demographics
NPI:1104880178
Name:JOYCE, EILEEN E (MD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:E
Last Name:JOYCE
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 1:150 WEST 100 NORTH
Mailing Address - Street 2:GL02
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078
Mailing Address - Country:US
Mailing Address - Phone:435-789-6962
Mailing Address - Fax:435-789-6961
Practice Address - Street 1:150 WEST 100 NORTH
Practice Address - Street 2:GL02
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078
Practice Address - Country:US
Practice Address - Phone:435-789-6962
Practice Address - Fax:435-789-6961
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187497207V00000X
CODR.0056060207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY15218OtherMVP PROVIDER #
NY160026706OtherRAILROAD MEDICARE
CO53730071Medicaid
NY10000992OtherCDPHP PROVIDER #
NY01473541Medicaid
NY01473541Medicaid
NYJ400070830Medicare PIN