Provider Demographics
NPI:1821053638
Name:ENGELS, JENNIFER EARLE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EARLE
Last Name:ENGELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:EARLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5899 PRESTON RD, SUITE 802
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5347
Mailing Address - Country:US
Mailing Address - Phone:972-965-2082
Mailing Address - Fax:
Practice Address - Street 1:5899 PRESTON RD, SUITE 802
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5347
Practice Address - Country:US
Practice Address - Phone:972-965-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK52902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152296301Medicaid
H64782Medicare UPIN