Provider Demographics
NPI:1891729315
Name:TEMPLE, JOHN R JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:TEMPLE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40517 ROUNDUP RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4644
Mailing Address - Country:US
Mailing Address - Phone:281-468-8379
Mailing Address - Fax:
Practice Address - Street 1:23330 EASTEX FWY
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4471
Practice Address - Country:US
Practice Address - Phone:832-777-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4743207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F9290OtherBCBSTX
TX131909714Medicaid
TX1891729315OtherTRICARE SOUTH
TX131909714Medicaid
TX930116425Medicare PIN
TXF44435Medicare UPIN