MEDICARE: MR. JOSE M PISCOYA M.D.

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	208D00000X	General Practice Physician	25569	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285685669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE M PISCOYA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1986
Second Line	:
City	:	SAN LUIS
State	:	AZ
Zip	:	85349-1986
Country	:	US
Telephone Number	:	928-722-6098
Fax Number	:	928-627-0007

Provider Business Practice Location Address
First Line	:	1962 E. JUAN SANCHEZ BULEVARD
Second Line	:	SUITE #1
City	:	SAN LUIS
State	:	AZ
Zip	:	85349
Country	:	US
Telephone Number	:	928-722-6098
Fax Number	:	928-627-0007

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/08/2007

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