Provider Demographics
NPI:1437157419
Name:JAMAL, SYED M (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:M
Last Name:JAMAL
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 1:709 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76458-1132
Mailing Address - Country:US
Mailing Address - Phone:817-565-0922
Mailing Address - Fax:940-567-6325
Practice Address - Street 1:717 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TX
Practice Address - Zip Code:76458-1111
Practice Address - Country:US
Practice Address - Phone:940-567-5528
Practice Address - Fax:940-567-6325
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000U47T2Medicaid
TXP000U47T2Medicaid
TX00U47TMedicare ID - Type Unspecified