Provider Demographics
NPI:1801079769
Name:JUAREZ, JYOTHI MAMIDI (MD)
Entity type:Individual
Prefix:DR
First Name:JYOTHI
Middle Name:MAMIDI
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 E MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4376
Mailing Address - Country:US
Mailing Address - Phone:713-929-0043
Mailing Address - Fax:713-929-0044
Practice Address - Street 1:205 E MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 2260
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4376
Practice Address - Country:US
Practice Address - Phone:713-929-0042
Practice Address - Fax:713-929-0044
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4995207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism