MEDICARE: JOEY GEE PA/C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1700260049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEY GEE PA/C

Provider Business Mailing Address
First Line	:	675 VFW PKWY
Second Line	:
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-3656
Country	:	US
Telephone Number	:	303-922-4636
Fax Number	:	303-922-4640

Provider Business Practice Location Address
First Line	:	675 VFW PKWY
Second Line	:
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-3656
Country	:	US
Telephone Number	:	303-922-4636
Fax Number	:	303-922-4640

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

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	07/16/2015

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