Provider Demographics
NPI:1578582458
Name:MASEK, JEANETTE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:LOUISE
Last Name:MASEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 WATER ST STE 104
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5200
Mailing Address - Country:US
Mailing Address - Phone:830-257-4124
Mailing Address - Fax:830-257-0041
Practice Address - Street 1:420 WATER ST STE 104
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5200
Practice Address - Country:US
Practice Address - Phone:830-257-4124
Practice Address - Fax:830-257-0041
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278348Medicare PIN
NED05128Medicare UPIN