Provider Demographics
NPI: | 1134651466 |
---|---|
Name: | GWOSDZ, JAMES (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JAMES |
Middle Name: | |
Last Name: | GWOSDZ |
Suffix: | |
Gender: | M |
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: | 1 BAYLOR PLZ |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77030-3498 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 713-798-4951 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 12222 MERIT DR STE 600 |
Practice Address - Street 2: | |
Practice Address - City: | DALLAS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75251-3294 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-715-5000 |
Practice Address - Fax: | 972-715-9976 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2017-03-28 |
Last Update Date: | 2023-10-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
246ZX2200X, 390200000X | ||
TX | BP30067001 | 390200000X |
TX | U4209 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | |
No | 246ZX2200X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Orthopedic Assistant |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |