Provider Demographics
NPI:1568760403
Name:JAYDAM SERVICES, LLC
Entity Type:Organization
Organization Name:JAYDAM SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-723-2549
Mailing Address - Street 1:6250 WESTPARK DR
Mailing Address - Street 2:321
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7322
Mailing Address - Country:US
Mailing Address - Phone:832-723-2549
Mailing Address - Fax:
Practice Address - Street 1:6250 WESTPARK DR
Practice Address - Street 2:321
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7322
Practice Address - Country:US
Practice Address - Phone:832-723-2549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty