Provider Demographics
NPI:1093711269
Name:JOHNSON-CALDWELL, JENNIFER LAVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LAVETTE
Last Name:JOHNSON-CALDWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1315 ST JOSEPH PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8233
Mailing Address - Country:US
Mailing Address - Phone:713-520-8963
Mailing Address - Fax:713-523-6941
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:713-520-8963
Practice Address - Fax:713-523-6941
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK5571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1571804-03Medicaid
H07989Medicare UPIN
TX8A6091Medicare ID - Type Unspecified