Provider Demographics
NPI:1114038825
Name:VIETS, JAYNE M (MD)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:M
Last Name:VIETS
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:P O BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9929207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN142691801Medicaid
TX142691804Medicaid
TX142691810 (MDACC)Medicaid
TXP00729519OtherRR MEDICARE (MDACC)
TX76068407077068OtherTRICARE
TX00096VOtherBC/BS
TX142691802Medicaid
TX8BH650OtherBCBS (MDACC)
TX8X6081OtherBCBS
TX142691804Medicaid
TN142691801Medicaid
TX142691810 (MDACC)Medicaid
TX8L8625 (MDACC)Medicare PIN