Provider Demographics
NPI:1811921448
Name:PHELAN, JAMES HARRY (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HARRY
Last Name:PHELAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23330 HIGHWAY 59 N STE 300
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4471
Mailing Address - Country:US
Mailing Address - Phone:281-359-3223
Mailing Address - Fax:281-359-2089
Practice Address - Street 1:23330 HIGHWAY 59 N STE 300
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4471
Practice Address - Country:US
Practice Address - Phone:281-359-3223
Practice Address - Fax:281-359-2089
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0067EYOtherBCBS
TX0067EYOtherBCBS
TXC20482Medicare UPIN
TX74-1929304OtherTAX ID NUMBER