Provider Demographics
NPI:1396934865
Name:KOMENDA, JEFFREY CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CRAIG
Last Name:KOMENDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:KOMENDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5944 W PARKER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6422
Mailing Address - Country:US
Mailing Address - Phone:972-608-1868
Mailing Address - Fax:972-943-8644
Practice Address - Street 1:5944 W PARKER RD
Practice Address - Street 2:100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6421
Practice Address - Country:US
Practice Address - Phone:972-608-1868
Practice Address - Fax:972-943-8644
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10018514OtherAMERIGROUP
TX165802301OtherMEDICAID GROUP
TX165802302OtherMEDICAID TEXAS HEALTH STE
TX124934405Medicaid
TX165802302OtherMEDICAID TEXAS HEALTH STE
TX10018514OtherAMERIGROUP