Basic Information
| Provider Information | |||||||||
| NPI: | 1609121722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOY | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | NICHOLS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1011 N MILDRED RD | ||||||||
| Address2: | |||||||||
| City: | CORTEZ | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813212435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705658482 | ||||||||
| FaxNumber: | 9705658478 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 RIVERGATE STE B4-81 | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813017485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702470937 | ||||||||
| FaxNumber: | 9702479579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2012 | ||||||||
| LastUpdateDate: | 12/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 7999311-1205 | UT | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 19142 | CO | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.