Provider Demographics
NPI:1386106391
Name:PRICE, JOSHUA LEE
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LEE
Last Name:PRICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 S PALOMINO PL
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-2444
Mailing Address - Country:US
Mailing Address - Phone:928-231-3978
Mailing Address - Fax:
Practice Address - Street 1:708 S COEUR D ALENE LN STE A
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5662
Practice Address - Country:US
Practice Address - Phone:928-472-7440
Practice Address - Fax:928-472-7536
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ226379207P00000X, 363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program