1659473742 NPI number — JEWEL ANNETTE GIACONA M.D.

Table of content: JEWEL ANNETTE GIACONA M.D. (NPI 1659473742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659473742 NPI number — JEWEL ANNETTE GIACONA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIACONA
Provider First Name:
JEWEL
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659473742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 WELFORD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77562-4539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-426-8072
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2802 GARTH RD
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
BAYTOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77521-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-428-0916
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  H8073 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TP11308207-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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