1841259322 NPI number — JOY GERISE WOLFE MD

Table of content: JOY GERISE WOLFE MD (NPI 1841259322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841259322 NPI number — JOY GERISE WOLFE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFE
Provider First Name:
JOY
Provider Middle Name:
GERISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILLIES
Provider Other First Name:
JOY
Provider Other Middle Name:
GERISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1841259322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4530 E RAY RD
Provider Second Line Business Mailing Address:
STE 150
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85044-6094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-875-4775
Provider Business Mailing Address Fax Number:
480-785-0908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4530 E RAY RD
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85044-6094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-875-4775
Provider Business Practice Location Address Fax Number:
480-785-0908
Provider Enumeration Date:
03/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  21990 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 311689 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".