Provider Demographics
NPI:1275615692
Name:JOKI, MELVIN T (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:T
Last Name:JOKI
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:701 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9164
Practice Address - Country:US
Practice Address - Phone:817-453-5437
Practice Address - Fax:817-453-2714
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4444208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX998298OtherUHC PIN
TX00U87ZOtherBCBSTX GRP PIN
TX148757OtherPHCS PIN
TX964639OtherFIRSTHEALTH PIN
TX7222201OtherCIGNA PIN
TX140442851Medicaid
TXJOKME48608OtherCCHIP PIN
TX116169100OtherFIRSTCARE PIN
1750369203OtherGRP NPI NUMBER
TX4126586OtherAETNA PIN
TX84560FOtherBCBSTX IND PIN
TX126317003Medicaid
TX140442882Medicaid
TX84560FMedicare PIN
TX998298OtherUHC PIN
TX964639OtherFIRSTHEALTH PIN