Provider Demographics
NPI:1700987500
Name:EDOKA, JO ANNE WISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JO ANNE
Middle Name:WISE
Last Name:EDOKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:805 E 32ND ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2537
Mailing Address - Country:US
Mailing Address - Phone:512-582-1201
Mailing Address - Fax:512-582-1205
Practice Address - Street 1:805 E 32ND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2537
Practice Address - Country:US
Practice Address - Phone:512-582-1201
Practice Address - Fax:512-582-1205
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ3788208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133377508Medicaid
TX133377508Medicaid
TXE84969Medicare UPIN