Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0101266148 | VA |
NPI | 1033644711 |
---|---|
Provider Name | Dr. Suzanne Jokajtys |
First Address | Converse, TX 78109-1837 |
Second Address | San Antonio, TX 78234-4504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2017 |
Last Update Date | 08/02/2019 |