Provider Demographics
NPI:1619355419
Name:PAWLOWSKI, JAMIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:PAWLOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:PINCKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2215 E VILLA MARIA RD STE 130
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2585
Mailing Address - Country:US
Mailing Address - Phone:979-774-0808
Mailing Address - Fax:
Practice Address - Street 1:2215 E VILLA MARIA RD STE 130
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2585
Practice Address - Country:US
Practice Address - Phone:979-774-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS57302085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty