Provider Demographics
NPI:1558425470
Name:DR. JENNIFER JOHNSON CALDWELL, MD, PA
Entity Type:Organization
Organization Name:DR. JENNIFER JOHNSON CALDWELL, MD, PA
Other - Org Name:NA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LAVETTE
Authorized Official - Last Name:JOHNSON-CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-654-4493
Mailing Address - Street 1:2450 LOUISIANA ST
Mailing Address - Street 2:400-716
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-2380
Mailing Address - Country:US
Mailing Address - Phone:713-520-8963
Mailing Address - Fax:713-523-6941
Practice Address - Street 1:1315 ST. JOSEPH'S PARKWAY
Practice Address - Street 2:#1309
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002
Practice Address - Country:US
Practice Address - Phone:713-654-4493
Practice Address - Fax:713-654-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC23208207QA0505X
TXK5571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15777101Medicaid
TX15777101Medicaid
TX00977UMedicare ID - Type Unspecified