Provider Demographics
NPI:1770761009
Name:DOE, JENNIFER WEN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:WEN
Last Name:DOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:WINNIE
Other - Last Name:WEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4620 N BRAESWOOD BLVD
Mailing Address - Street 2:APT 416
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-2845
Mailing Address - Country:US
Mailing Address - Phone:315-323-0236
Mailing Address - Fax:
Practice Address - Street 1:2424 W HOLCOMBE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1934
Practice Address - Country:US
Practice Address - Phone:832-804-8119
Practice Address - Fax:832-804-8120
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA084103002085R0202X
TXP29802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ157518Medicare PIN