Provider Demographics
NPI:1487768131
Name:JOY, ELIZABETH ANNE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:JOY
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 S STATE ST FL 16
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1633
Mailing Address - Country:US
Mailing Address - Phone:801-442-3721
Mailing Address - Fax:
Practice Address - Street 1:389 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2310
Practice Address - Country:US
Practice Address - Phone:385-282-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT292905-1205207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT219769OtherDMBA
WA7081524Medicaid
UT870564069J01OtherEMIA TAX ID 870564069
UTQM0000053181OtherALTIUS TAX ID 870564069
UT107007428101OtherIHC TAX ID 870564069
UT190475000OtherDOL TAX ID 870564069
UT2054OtherUUHP
UT43463OtherPEHP TAX ID 870564069
UTD1008Medicaid
UT284035OtherALTIUS TAX ID 830458867
UT89274OtherPEHP TAX ID 830458867
UT190475000OtherDOL TAX ID 870564069
F35363Medicare UPIN
UT005516005Medicare ID - Type UnspecifiedTAX ID 870564069