Provider Demographics
NPI:1225258551
Name:MANKOVSKY, JERALD ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:ALAN
Last Name:MANKOVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 MEDICAL PKWY
Mailing Address - Street 2:#220
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1019
Mailing Address - Country:US
Mailing Address - Phone:512-451-9055
Mailing Address - Fax:512-451-2087
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:#220
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1019
Practice Address - Country:US
Practice Address - Phone:512-451-9055
Practice Address - Fax:512-451-2087
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6490207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115506101Medicaid
TXMF42Medicare ID - Type Unspecified
TX115506101Medicaid