Provider Demographics
NPI:1902233869
Name:JEANETTE L MASEK MD PLLC
Entity Type:Organization
Organization Name:JEANETTE L MASEK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MASEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-257-4124
Mailing Address - Street 1:420 WATER ST STE 104
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5200
Mailing Address - Country:US
Mailing Address - Phone:830-257-4124
Mailing Address - Fax:830-257-0041
Practice Address - Street 1:420 WATER ST STE 104
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5200
Practice Address - Country:US
Practice Address - Phone:830-257-4124
Practice Address - Fax:830-257-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty