Provider Demographics
NPI:1093808180
Name:MAUK, JOYCE E (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:E
Last Name:MAUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W LANCASTER
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-3484
Mailing Address - Country:US
Mailing Address - Phone:817-336-2823
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:1300 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3410
Practice Address - Country:US
Practice Address - Phone:817-336-8611
Practice Address - Fax:682-336-2823
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK61342080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140442813Medicaid
TX060976001Medicaid
TX118781100OtherFIRSTCARE PIN
1548230923OtherGRP NPI NUMBER
TX10024054OtherAMERIGROUP PIN
TX4416581OtherAETNA PIN
TX0026CVOtherBCBSTX GRP PIN
TX1840371OtherUHC PIN
TX43655OtherFIRSTHEALTH PIN
TX492577OtherPHCS PIN
TX4338797OtherCIGNA PIN
TX124160OtherSUPERIOR PIN
TX82861SOtherBCBSTX IND PIN
TX492577OtherPHCS PIN
TX0026CVOtherBCBSTX GRP PIN
TX060976001Medicare ID - Type UnspecifiedIND TPI NUMBER
TX82861SOtherBCBSTX IND PIN
TX0030BVMedicare PIN
TX060976001Medicare PIN
TX10024054OtherAMERIGROUP PIN