Provider Demographics
NPI:1770710873
Name:FIELDS-GILMORE, JO ANNA R (MD)
Entity type:Individual
Prefix:
First Name:JO ANNA
Middle Name:R
Last Name:FIELDS-GILMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:R
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-6206
Mailing Address - Country:US
Mailing Address - Phone:713-878-6786
Mailing Address - Fax:979-245-0744
Practice Address - Street 1:1100 W 34TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-6206
Practice Address - Country:US
Practice Address - Phone:713-718-8768
Practice Address - Fax:979-245-0744
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP3529OtherTEXAS MEDICAL BOARD LICENSE