MEDICARE: JOYCE ELLEN DORSEY P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	1112	OK

General Provider Information

NPI Number	:	1205813136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE ELLEN DORSEY P.A.

Provider Business Mailing Address
First Line	:	1011 HONOR HEIGHTS DR
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-1318
Country	:	US
Telephone Number	:	918-577-3997
Fax Number	:	918-577-3879

Provider Business Practice Location Address
First Line	:	1011 HONOR HEIGHTS DR
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-1318
Country	:	US
Telephone Number	:	918-577-3997
Fax Number	:	918-577-3879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	01/06/2015

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