Provider Demographics
NPI:1750356994
Name:SPEDALE, JEANNE H (MD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:H
Last Name:SPEDALE
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 1:7737 SW FWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1807
Mailing Address - Country:US
Mailing Address - Phone:713-981-4444
Mailing Address - Fax:713-981-5548
Practice Address - Street 1:7737 SW FWY
Practice Address - Street 2:SUITE 350
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1807
Practice Address - Country:US
Practice Address - Phone:713-981-4444
Practice Address - Fax:713-981-5548
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1933174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83281KMedicare ID - Type Unspecified
TXG63835Medicare UPIN