Basic Information
| Provider Information | |||||||||
| NPI: | 1093808180 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAUK | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1300 W LANCASTER | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761023484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173362823 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 W LANCASTER AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761023410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173368611 | ||||||||
| FaxNumber: | 6823362823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 02/05/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0008X | K6134 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neurodevelopmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 140442813 | 05 | TX | MEDICAID | 060976001 | 05 | TX | MEDICAID | 118781100 | 01 | TX | FIRSTCARE PIN | OTHER | 1548230923 | 01 | GRP NPI NUMBER | OTHER | 10024054 | 01 | TX | AMERIGROUP PIN | OTHER | 4416581 | 01 | TX | AETNA PIN | OTHER | 0026CV | 01 | TX | BCBSTX GRP PIN | OTHER | 1840371 | 01 | TX | UHC PIN | OTHER | 43655 | 01 | TX | FIRSTHEALTH PIN | OTHER | 492577 | 01 | TX | PHCS PIN | OTHER | 4338797 | 01 | TX | CIGNA PIN | OTHER | 124160 | 01 | TX | SUPERIOR PIN | OTHER | 82861S | 01 | TX | BCBSTX IND PIN | OTHER |