Healthcare Provider Details

I. General information

NPI: 1760478630
Provider Name (Legal Business Name): CHARLES B JOYCE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 ROYAL AVE
MONROE LA
71201-5724
US

IV. Provider business mailing address

PO BOX 14474
MONROE LA
71207-4474
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-5435
  • Fax: 318-325-8852
Mailing address:
  • Phone: 318-325-5435
  • Fax: 318-325-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number20142
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: