Provider Demographics
NPI:1043952617
Name:JMJ MEDICAL GROUP (DE), P.A.
Entity Type:Organization
Organization Name:JMJ MEDICAL GROUP (DE), P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANAN
Authorized Official - Middle Name:U
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-693-3222
Mailing Address - Street 1:8951 CYPRESS WATERS BLVD STE 160-1045
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4661
Mailing Address - Country:US
Mailing Address - Phone:972-693-3222
Mailing Address - Fax:
Practice Address - Street 1:8951 CYPRESS WATERS BLVD STE 160-1045
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4661
Practice Address - Country:US
Practice Address - Phone:972-693-3222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty