Provider Demographics
NPI:1235457540
Name:GOETZ, JESSICA TSAI (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:TSAI
Last Name:GOETZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:C
Other - Last Name:TSAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7703 FLOYD CURL DR # MC7977
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-9600
Mailing Address - Fax:210-450-6036
Practice Address - Street 1:8300 FLOYD CURL DR FL 4
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-450-9600
Practice Address - Fax:210-450-6036
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP63962088P0231X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX385409302OtherCSHCN
TX385409301Medicaid