Provider Demographics
NPI:1811973274
Name:ZAGURSKY, JOYCE A (MD)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:A
Last Name:ZAGURSKY
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 1:900 SIM HODGIN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1932
Mailing Address - Country:US
Mailing Address - Phone:765-965-4800
Mailing Address - Fax:765-965-4855
Practice Address - Street 1:900 SIM HODGIN PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1932
Practice Address - Country:US
Practice Address - Phone:765-965-4800
Practice Address - Fax:765-965-4855
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061310A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B38820Medicare UPIN
IN237130AMedicare PIN