Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 0762 | TX |
NPI | 1174699409 |
---|---|
Provider Name | Dr. Judith Ann Jonke |
First Address | New Braunfels, TX 78130-3556 |
Second Address | New Braunfels, TX 78130-3556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 07/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0188195-01 | (05) | TX |
T14105 | (02) | TX |