Provider Demographics
NPI:1912082355
Name:THEARD, JOYCELYN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JOYCELYN
Middle Name:MARIE
Last Name:THEARD
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 1:19284 STONE OAK PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3474
Mailing Address - Country:US
Mailing Address - Phone:210-268-0120
Mailing Address - Fax:210-268-0170
Practice Address - Street 1:19284 STONE OAK PKWY STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3474
Practice Address - Country:US
Practice Address - Phone:210-268-0120
Practice Address - Fax:210-268-0170
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4594207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034507602Medicaid
TXA0038460OtherDPS
TXA0038460OtherDPS
TX00KN05Medicare ID - Type Unspecified
TXAT8922812OtherDEA