Provider Demographics
NPI:1750323127
Name:JENNIFER GWOZDZ MD PA
Entity Type:Organization
Organization Name:JENNIFER GWOZDZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:GWOZDZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-530-4057
Mailing Address - Street 1:3402 HIGHWAY 6 S
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-4202
Mailing Address - Country:US
Mailing Address - Phone:281-530-4057
Mailing Address - Fax:281-530-0649
Practice Address - Street 1:3402 HIGHWAY 6 S
Practice Address - Street 2:SUITE D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-4202
Practice Address - Country:US
Practice Address - Phone:281-530-4057
Practice Address - Fax:281-530-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111440701Medicaid
TX111440702Medicaid
TXHF24Medicare PIN
TX0086ZYMedicare ID - Type Unspecified
TX111440701Medicaid