Provider Demographics
NPI:1669487526
Name:FUERST, JAN FREDRIC (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:FREDRIC
Last Name:FUERST
Suffix:
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 1:909 FROSTWOOD
Mailing Address - Street 2:STE 311
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2309
Mailing Address - Country:US
Mailing Address - Phone:713-468-7033
Mailing Address - Fax:
Practice Address - Street 1:909 FROSTWOOD
Practice Address - Street 2:STE 311
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2309
Practice Address - Country:US
Practice Address - Phone:713-468-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8226207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2222809OtherBLUE CROSS BLUE SHIELD
TX826073125OtherRAILROAD MEDICARE
TX2222809OtherBLUE CROSS BLUE SHIELD
B2222809Medicare UPIN