Provider Demographics
NPI:1417375379
Name:JD UNITED, PA
Entity Type:Organization
Organization Name:JD UNITED, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:FUKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-991-2200
Mailing Address - Street 1:3917 PEBBLE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3766
Mailing Address - Country:US
Mailing Address - Phone:832-524-5355
Mailing Address - Fax:281-991-7700
Practice Address - Street 1:7111 MEDICAL CENTER DR
Practice Address - Street 2:SUITE #111
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2666
Practice Address - Country:US
Practice Address - Phone:281-991-2200
Practice Address - Fax:281-991-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6138208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6987950001OtherPTAN