Basic Information
| Provider Information | |||||||||
| NPI: | 1285697292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCINTOSH | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | HOWARD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 ESPLANADE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959263315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308980504 | ||||||||
| FaxNumber: | 5308989647 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 ESPLANADE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959263315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308980504 | ||||||||
| FaxNumber: | 5308989647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | RHL122711 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | BM2585834 | 01 | DEA | OTHER | C39880 | 01 | CA | MEDICAL LICENSE | OTHER | 00C398800 | 05 | CA | MEDICAID |