Provider Demographics
NPI:1417035692
Name:HUSSEY, JIM PASCAL (DO)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:PASCAL
Last Name:HUSSEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 W CAMPBELL RD
Mailing Address - Street 2:SUITE 204 MEDICAL PLAZA II
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3606
Mailing Address - Country:US
Mailing Address - Phone:972-234-8868
Mailing Address - Fax:972-234-8466
Practice Address - Street 1:399 W CAMPBELL RD
Practice Address - Street 2:SUITE 204 MEDICAL PLAZA II
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3606
Practice Address - Country:US
Practice Address - Phone:972-234-8868
Practice Address - Fax:972-234-8466
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D72480Medicare UPIN
TX00B30KMedicare PIN