Provider Demographics
NPI:1851335962
Name:CULVER, JENNIFER LEA (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEA
Last Name:CULVER
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 1:2800 S TEXAS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5361
Mailing Address - Country:US
Mailing Address - Phone:936-266-3513
Mailing Address - Fax:713-852-2332
Practice Address - Street 1:2210 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-1903
Practice Address - Country:US
Practice Address - Phone:979-821-6300
Practice Address - Fax:979-823-4545
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133470809Medicaid
TX133470808OtherMEDICAID OTHER
TX133470807Medicaid
TX080179157OtherRAILROAD MEDICARE
TX133470807Medicaid