Provider Demographics
NPI:1659473742
Name:GIACONA, JEWEL ANNETTE (MD)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:ANNETTE
Last Name:GIACONA
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 1:415 WELFORD LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77562-4539
Mailing Address - Country:US
Mailing Address - Phone:281-426-8072
Mailing Address - Fax:
Practice Address - Street 1:2802 GARTH RD
Practice Address - Street 2:SUITE 211
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3900
Practice Address - Country:US
Practice Address - Phone:281-428-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTP11308207-02Medicaid
TXF77988Medicare UPIN
TX00116M=00116*61Medicare ID - Type Unspecified