Provider Demographics
NPI:1245596253
Name:COLLETTE, JEREMY CHARLES (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:CHARLES
Last Name:COLLETTE
Suffix:
Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:7026 OLD KATY RD STE 276
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2187
Mailing Address - Country:US
Mailing Address - Phone:713-621-7436
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:7026 OLD KATY RD STE 276
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2187
Practice Address - Country:US
Practice Address - Phone:713-621-7436
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXR67622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology