Individual
MARY THEOKTISTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 MEDICAL PKWY, LAKEWAY, TX 78738-5621
(512) 571-5000
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-8800
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
S3323
TX
Other
Enumeration date
06/11/2015
Last updated
08/20/2020
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