Provider Demographics
NPI:1588684021
Name:JENEVEIN, EDWIN PATRICK JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:PATRICK
Last Name:JENEVEIN
Suffix:JR
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 1:8267 ELMBROOK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4030
Mailing Address - Country:US
Mailing Address - Phone:214-237-1664
Mailing Address - Fax:214-237-1864
Practice Address - Street 1:5909 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6209
Practice Address - Country:US
Practice Address - Phone:214-645-5382
Practice Address - Fax:214-645-3537
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC9220207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80P356OtherBCBS
B23749Medicare UPIN
TX80P356OtherBCBS