Provider Demographics
NPI:1275528978
Name:THAYIL, JOSEPH JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:THAYIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 780566
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-0566
Mailing Address - Country:US
Mailing Address - Phone:210-646-0800
Mailing Address - Fax:210-590-6997
Practice Address - Street 1:4129 NACO PERRIN BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2505
Practice Address - Country:US
Practice Address - Phone:210-722-8106
Practice Address - Fax:210-275-0080
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2153207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM2153OtherMEDICAL LICENSE
TXI37352Medicare UPIN