Provider Demographics
NPI:1700172426
Name:LIEDTKE, JENNIFER GAIL SINCLAIR (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:GAIL SINCLAIR
Last Name:LIEDTKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:GAIL
Other - Last Name:SINCLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 JENNY GEORGE LN
Mailing Address - Street 2:STE 6B
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-7152
Mailing Address - Country:US
Mailing Address - Phone:325-235-6819
Mailing Address - Fax:325-235-6824
Practice Address - Street 1:301 JENNY GEORGE LN
Practice Address - Street 2:SUITE B6
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-7152
Practice Address - Country:US
Practice Address - Phone:325-235-6819
Practice Address - Fax:325-235-6824
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3919207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology