Provider Demographics
NPI:1073739090
Name:LISA M. JUKES, MD, PA
Entity Type:Organization
Organization Name:LISA M. JUKES, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:JUKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-301-6767
Mailing Address - Street 1:5656 BEE CAVE RD
Mailing Address - Street 2:SUITE B101
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5280
Mailing Address - Country:US
Mailing Address - Phone:512-301-6767
Mailing Address - Fax:512-301-6776
Practice Address - Street 1:5656 BEE CAVE RD
Practice Address - Street 2:SUITE B101
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5280
Practice Address - Country:US
Practice Address - Phone:512-301-6767
Practice Address - Fax:512-301-6776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6767207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0008KPOtherBCBS GROUP
TX286813OtherSCOTT & WHITE
TX8K1560OtherBCBS INDIVIDUAL
TX8K1560OtherBCBS INDIVIDUAL
TX=========OtherTAX ID
TX8K1560OtherBCBS INDIVIDUAL
TX8B3224Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL