Provider Demographics
NPI:1124476403
Name:PRICE, JOAN PORTER (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:PORTER
Last Name:PRICE
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 1:37110 FOX CHASE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1810
Mailing Address - Country:US
Mailing Address - Phone:248-661-5266
Mailing Address - Fax:248-661-5266
Practice Address - Street 1:37110 FOX CHASE
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1810
Practice Address - Country:US
Practice Address - Phone:248-661-5266
Practice Address - Fax:248-661-5266
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine