Provider Demographics
NPI:1154399871
Name:KALMER, JENNIFER LYNN (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:KALMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 W FRANK AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3340
Mailing Address - Country:US
Mailing Address - Phone:936-631-6792
Mailing Address - Fax:936-631-6793
Practice Address - Street 1:1105 W FRANK AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3303
Practice Address - Country:US
Practice Address - Phone:936-631-6792
Practice Address - Fax:936-631-6793
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30502208100000X
TXP8259208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330569001Medicaid
AZ717449Medicaid
AZG07374Medicare UPIN
AZ71118Medicare PIN
TX330569001Medicaid