Provider Demographics
NPI:1659341717
Name:DERZAPF, JENNIFER BAUDAT (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BAUDAT
Last Name:DERZAPF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16605 SOUTHWEST FWY STE 400
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3500
Mailing Address - Country:US
Mailing Address - Phone:281-275-0800
Mailing Address - Fax:281-275-0801
Practice Address - Street 1:16605 SOUTHWEST FWY STE 400
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3500
Practice Address - Country:US
Practice Address - Phone:281-275-0800
Practice Address - Fax:281-275-0801
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045860603Medicaid
TX045860604Medicaid
TX045860602Medicaid
TX8EF695OtherBLUE CROSS BLUE SHIELD
TX045860601Medicaid
TX080165741OtherRAILROAD MEDICARE
TX1659341717OtherBLUE CROSS BLUE SHIELD
TX8CE139OtherBLUE CROSS BLUE SHIELD
TX080165741OtherRAILROAD MEDICARE
TX1659341717OtherBLUE CROSS BLUE SHIELD
TX045860601Medicaid
TX8CE139OtherBLUE CROSS BLUE SHIELD
TX045860604Medicaid