Provider Demographics
NPI:1760417869
Name:TAMM, AUDREY KAREN (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:KAREN
Last Name:TAMM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4800 W PANTHER CREEK DR
Mailing Address - Street 2:STE 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2563
Mailing Address - Country:US
Mailing Address - Phone:281-364-8600
Mailing Address - Fax:281-298-2005
Practice Address - Street 1:4800 W PANTHER CREEK DR
Practice Address - Street 2:STE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2563
Practice Address - Country:US
Practice Address - Phone:281-364-8600
Practice Address - Fax:281-298-2005
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ0300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX731653079OtherTAX ID
TX135944010Medicaid
TX8F9554Medicare PIN
TX731653079OtherTAX ID