Provider Demographics
NPI:1164578910
Name:DOLAN, JEAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:T
Last Name:DOLAN
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 1:10909 I-10 EAST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-1911
Mailing Address - Country:US
Mailing Address - Phone:713-973-7943
Mailing Address - Fax:713-973-7947
Practice Address - Street 1:10909 I-10 EAST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-1911
Practice Address - Country:US
Practice Address - Phone:713-973-7943
Practice Address - Fax:713-973-7947
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7273171W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ7273OtherMEDICAL LICENSE
TXJ7273OtherMEDICAL LICENSE
TX8L22118Medicare UPIN