Provider Demographics
NPI:1912913666
Name:JUKES, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:JUKES
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 1:5656 BEE CAVES RD STE B101
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5281
Mailing Address - Country:US
Mailing Address - Phone:512-301-6767
Mailing Address - Fax:512-301-6776
Practice Address - Street 1:3944 RR 620 SOUTH
Practice Address - Street 2:BUILDING 8, SUITE 208
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-7000
Practice Address - Country:US
Practice Address - Phone:512-301-6767
Practice Address - Fax:512-301-6776
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6767207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K1560OtherBCBS INDIVIDUAL
TX0008KPOtherBCBS GROUP
TX286813OtherSCOTT & WHITE
TX680559223OtherTAX ID
TX0008KPOtherBCBS GROUP
TXH24245Medicare UPIN
TX286813OtherSCOTT & WHITE