Provider Demographics
NPI:1922067339
Name:GAMMON, JANE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:E
Last Name:GAMMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JANE
Other - Middle Name:GAMMON
Other - Last Name:AGUIRRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1809 SW H.K. DODGEN LOOP
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-0000
Mailing Address - Country:US
Mailing Address - Phone:254-778-5400
Mailing Address - Fax:254-778-5444
Practice Address - Street 1:1809 SW H.K. DODGEN LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-0000
Practice Address - Country:US
Practice Address - Phone:254-778-5400
Practice Address - Fax:254-778-5444
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH2392OtherTX LICENSE
TX8L13040Medicare PIN
TXH2392OtherTX LICENSE