Provider Demographics
NPI:1366732398
Name:WORTHAM, JOY MARISSA (MD)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:MARISSA
Last Name:WORTHAM
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 1:1355 CENTRAL PKWY S STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5057
Mailing Address - Country:US
Mailing Address - Phone:210-653-5501
Mailing Address - Fax:
Practice Address - Street 1:7323 N LOOP 1604 E STE 601
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-2956
Practice Address - Country:US
Practice Address - Phone:210-650-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-0550207R00000X
TXR0163207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX366322103Medicaid
TX366322102OtherCSHCN
TX366322101Medicaid