Provider Demographics
NPI:1255077780
Name:SON, JEANNE SUE (MD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:SUE
Last Name:SON
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 1:7132 N HOLIDAY DR APT 7132
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-3032
Mailing Address - Country:US
Mailing Address - Phone:956-578-9826
Mailing Address - Fax:
Practice Address - Street 1:11937 US HIGHWAY 271 # B-410
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75708-3154
Practice Address - Country:US
Practice Address - Phone:903-877-7253
Practice Address - Fax:903-877-8111
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program