Provider Demographics
NPI:1437134491
Name:TERRY, JAMIE ELIZABETH (MD)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ELIZABETH
Last Name:TERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:SUITE 480
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:713-522-8905
Practice Address - Fax:713-820-6377
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8455208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134164608Medicaid
TX134164610Medicaid
TX134164609Medicaid
TXP00868150OtherRAILROAD MEDICARE
TXTXB110881Medicare PIN
TX134164610Medicaid
TXTXB110878Medicare PIN