Provider Demographics
NPI:1801833314
Name:MAUST, JOEL RUSSEL (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:RUSSEL
Last Name:MAUST
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 1:3310 OAKWELL CT APT 16304
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3980
Mailing Address - Country:US
Mailing Address - Phone:214-282-6594
Mailing Address - Fax:
Practice Address - Street 1:3310 OAKWELL CT APT 16304
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3980
Practice Address - Country:US
Practice Address - Phone:214-282-6594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U61EOtherMEDICARE GROUP NUMBER
TX155581501Medicaid
TX155581503OtherMEDICAID OTHER
TX155581501Medicaid
TX155581503OtherMEDICAID OTHER
TX8L3221Medicare PIN