MEDICARE: DR. RICHARD GRANT JOSLIN 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	207Q00000X	Family Medicine Physician	21665	NC
2	207Q00000X	Family Medicine Physician	20328	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A3700	OTHER	NC	MEDCOST
2	47509	OTHER	NC	BLUE CROSS

General Provider Information

NPI Number	:	1801901566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD GRANT JOSLIN M.D.

Provider Business Mailing Address
First Line	:	601 OTTERCREEK
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-4045
Country	:	US
Telephone Number	:	910-458-0371
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 21ST AVE N
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-7401
Country	:	US
Telephone Number	:	843-626-9379
Fax Number	:

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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