Provider Demographics
NPI:1558716142
Name:JACKSON, JOYCE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:MARIE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:
Other - Last Name:HAYNES BUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 691989
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-1989
Mailing Address - Country:US
Mailing Address - Phone:832-599-8081
Mailing Address - Fax:832-327-7868
Practice Address - Street 1:600 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2235
Practice Address - Country:US
Practice Address - Phone:832-599-8081
Practice Address - Fax:832-327-7868
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1780208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist