Provider Demographics
NPI:1770549057
Name:OAKMAN, JERRY D (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:D
Last Name:OAKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12850 JONES RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4955
Mailing Address - Country:US
Mailing Address - Phone:281-890-8610
Mailing Address - Fax:281-890-8613
Practice Address - Street 1:12850 JONES ROAD
Practice Address - Street 2:STE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:281-890-8610
Practice Address - Fax:281-890-8613
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE3078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00R077Medicare ID - Type Unspecified
TXB25213Medicare UPIN