Provider Demographics
NPI:1700812914
Name:BREEZE, JILL E (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:E
Last Name:BREEZE
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 1:300 N HIGHLAND AVE STE 550
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7390
Mailing Address - Country:US
Mailing Address - Phone:903-957-7429
Mailing Address - Fax:903-957-7424
Practice Address - Street 1:300 N HIGHLAND AVE STE 550
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7390
Practice Address - Country:US
Practice Address - Phone:903-957-7429
Practice Address - Fax:903-957-7424
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161041202Medicaid
TX161041204Medicaid
TX161041203Medicaid
TX161041201Medicaid
TX161041204Medicaid
TX161041201Medicaid
H94575Medicare UPIN
TX161041202Medicaid
TX8L18883Medicare PIN