Provider Demographics
NPI:1669581591
Name:EAMES, GRETCHEN M (MD)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:M
Last Name:EAMES
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-4007
Practice Address - Fax:682-885-3914
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9008207RH0003X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10028739OtherAMERIGROUP PIN
TX112080100OtherFIRSTCARE PIN
TX104072OtherSUPERIOR PIN
TX81X464OtherBCBSTX IND PIN
TX00U87ZOtherBCBSTX GRP PIN
TX9815647OtherCIGNA PIN
1750369203OtherGRP NPI NUMBER
TX413450OtherPHCS PIN
TX4628807OtherAETNA PIN
TX106394303Medicaid
TX1392686OtherUHC PIN
TX106394304OtherCSHCN
TX1640329OtherFIRSTHEALTH PIN
TX106394304OtherCSHCN