MEDICARE: GREGORY AUSTIN JOY MD

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	207QA0505X	Adult Medicine Physician	C29503	CA

General Provider Information

NPI Number	:	1114635406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY AUSTIN JOY MD

Provider Business Mailing Address
First Line	:	6166 PLEASANT VALLEY RD UNIT 79
Second Line	:
City	:	EL DORADO
State	:	CA
Zip	:	95623-5503
Country	:	US
Telephone Number	:	530-622-9522
Fax Number	:	520-626-6888

Provider Business Practice Location Address
First Line	:	6221 MONITOR RD
Second Line	:
City	:	EL DORADO
State	:	CA
Zip	:	95623-4534
Country	:	US
Telephone Number	:	530-622-9522
Fax Number	:	530-626-6888

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

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	11/07/2022

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