Provider Demographics
NPI:1649367293
Name:JELINEK, GREGORY (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:JELINEK
Suffix:
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 1:10314 GLENNSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NAVASOTA
Mailing Address - State:TX
Mailing Address - Zip Code:77868-6306
Mailing Address - Country:US
Mailing Address - Phone:936-825-7134
Mailing Address - Fax:
Practice Address - Street 1:10314 GLENNSWOOD DR
Practice Address - Street 2:
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868-6306
Practice Address - Country:US
Practice Address - Phone:936-825-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG10502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00236698OtherRAILROAD MEDICARE
ARP00236698OtherRAILROAD MEDICARE
E07947Medicare UPIN
AR5N090Medicare PIN