Provider Demographics
NPI:1700839123
Name:DJOKOVIC, MARIJA (MD)
Entity Type:Individual
Prefix:
First Name:MARIJA
Middle Name:
Last Name:DJOKOVIC
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:PO BOX 732973
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2973
Mailing Address - Country:US
Mailing Address - Phone:817-702-2450
Mailing Address - Fax:817-702-8445
Practice Address - Street 1:4701 BRYANT IRVIN RD N
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7627
Practice Address - Country:US
Practice Address - Phone:817-702-3100
Practice Address - Fax:817-569-1527
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM07042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174743802Medicaid
TX8GA571OtherACCLAIM BCBS
TX8U1292OtherBCBS
TXP00837813OtherRAILROAD MEDICARE
TX8D9024Medicare PIN
TX8GA571OtherACCLAIM BCBS