Basic Information
| Provider Information | |||||||||
| NPI: | 1770586331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHOTWELL | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 GASTON AVE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752461541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148244412 | ||||||||
| FaxNumber: | 2148244431 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 GASTON AVE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752461541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148244412 | ||||||||
| FaxNumber: | 2148244431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 01/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | F4525 | TX | Y | Other Service Providers | Specialist | 207RP1001X | F4525 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | F4525 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 120108905 | 05 | TX | MEDICAID | 0069EY | 01 | TX | BCBS | OTHER |