Provider Demographics
NPI:1306208665
Name:AU, JEREMIAH (MD)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:
Last Name:AU
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 1:2950 CULLEN BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3922
Mailing Address - Country:US
Mailing Address - Phone:281-412-6262
Mailing Address - Fax:281-412-6740
Practice Address - Street 1:430 S MASON RD STE 101
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2448
Practice Address - Country:US
Practice Address - Phone:281-392-3803
Practice Address - Fax:281-392-6766
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS9648207N00000X, 207ND0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program