Provider Demographics
NPI:1174699409
Name:JONKE, JUDITH ANN (DPM)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:JONKE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 LOOP 337
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3556
Mailing Address - Country:US
Mailing Address - Phone:830-629-7233
Mailing Address - Fax:830-620-5679
Practice Address - Street 1:925 LOOP 337
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3556
Practice Address - Country:US
Practice Address - Phone:830-629-7233
Practice Address - Fax:830-620-5679
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0762213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0188195-01Medicaid
TX1071760001Medicare NSC
TXT14105Medicare UPIN
TXSD-37Medicare PIN