Provider Demographics
NPI:1003834714
Name:D'ETIENNE, JAMES PIERRE (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:PIERRE
Last Name:D'ETIENNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 41633
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-1633
Mailing Address - Country:US
Mailing Address - Phone:800-355-0808
Mailing Address - Fax:214-712-2487
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:214-820-2505
Practice Address - Fax:214-712-2487
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK6455207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH12818Medicare UPIN