Healthcare Provider Details

I. General information

NPI: 1366732398
Provider Name (Legal Business Name): JOY MARISSA WORTHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7323 N LOOP 1604 E STE 601
SAN ANTONIO TX
78233-2956
US

IV. Provider business mailing address

1355 CENTRAL PKWY S STE 400
SAN ANTONIO TX
78232-5057
US

V. Phone/Fax

Practice location:
  • Phone: 210-650-3360
  • Fax:
Mailing address:
  • Phone: 210-653-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2014-0550
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberR0163
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: