Provider Demographics
NPI:1861677874
Name:JANICE A MUDD DO
Entity Type:Organization
Organization Name:JANICE A MUDD DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MUDD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:281-558-1888
Mailing Address - Street 1:12121 RICHMOND AVE
Mailing Address - Street 2:#325
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2456
Mailing Address - Country:US
Mailing Address - Phone:281-558-1888
Mailing Address - Fax:281-558-4411
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:#325
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2456
Practice Address - Country:US
Practice Address - Phone:281-558-1888
Practice Address - Fax:281-558-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80150BMedicare PIN