Basic Information
| Provider Information | |||||||||
| NPI: | 1275615692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOKI | ||||||||
| FirstName: | MELVIN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 MATLOCK RD | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760639164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174535437 | ||||||||
| FaxNumber: | 8174532714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 04/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | H4444 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 998298 | 01 | TX | UHC PIN | OTHER | 00U87Z | 01 | TX | BCBSTX GRP PIN | OTHER | 148757 | 01 | TX | PHCS PIN | OTHER | 964639 | 01 | TX | FIRSTHEALTH PIN | OTHER | 7222201 | 01 | TX | CIGNA PIN | OTHER | 140442851 | 05 | TX | MEDICAID | JOKME48608 | 01 | TX | CCHIP PIN | OTHER | 116169100 | 01 | TX | FIRSTCARE PIN | OTHER | 1750369203 | 01 | GRP NPI NUMBER | OTHER | 4126586 | 01 | TX | AETNA PIN | OTHER | 84560F | 01 | TX | BCBSTX IND PIN | OTHER | 126317003 | 05 | TX | MEDICAID | 140442882 | 05 | TX | MEDICAID |