MEDICARE: MRS. JOYCE J. CARR MASTERS DEGREE

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	177F00000X	Lodging Provider	112363	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1012158	OTHER	TX	PROVIDER NUMBER

General Provider Information

NPI Number	:	1619962123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOYCE J. CARR MASTERS DEGREE

Provider Business Mailing Address
First Line	:	1655 N JIM MILLER RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-1321
Country	:	US
Telephone Number	:	214-391-2178
Fax Number	:	214-391-2178

Provider Business Practice Location Address
First Line	:	1655 N JIM MILLER RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-1321
Country	:	US
Telephone Number	:	214-391-2178
Fax Number	:	214-391-2178

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/08/2007

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