Provider Demographics
NPI:1598702037
Name:GWOZDZ, JENNIFER S (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:GWOZDZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:S
Other - Last Name:GWOZDZ-DREW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3402 HIGHWAY 6 SOUTH
Mailing Address - Street 2:STE D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-4207
Mailing Address - Country:US
Mailing Address - Phone:281-530-4057
Mailing Address - Fax:281-530-0649
Practice Address - Street 1:3402 HIGHWAY 6 SOUTH
Practice Address - Street 2:STE D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-0649
Practice Address - Country:US
Practice Address - Phone:281-530-4057
Practice Address - Fax:281-530-0694
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111440701Medicaid
TX111440701Medicaid
TX0086ZYMedicare PIN