Provider Demographics
NPI:1669738522
Name:JAMES, JOBY THEKKUMKEL (MD)
Entity type:Individual
Prefix:
First Name:JOBY
Middle Name:THEKKUMKEL
Last Name:JAMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOBY
Other - Middle Name:JAMES
Other - Last Name:THEKKUMKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5501 INDEPENDENCE PKWY
Mailing Address - Street 2:STE 110
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5463
Mailing Address - Country:US
Mailing Address - Phone:972-596-1747
Mailing Address - Fax:972-985-9775
Practice Address - Street 1:5501 INDEPENDENCE PKWY
Practice Address - Street 2:STE 110
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5463
Practice Address - Country:US
Practice Address - Phone:972-596-1747
Practice Address - Fax:972-985-9775
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29122207R00000X
TXR1548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX567020YNGSMedicaid
TX567020YL7AMedicaid
TX567020YL7BMedicaid
TX567020YL7BMedicaid