Provider Demographics
NPI:1306005582
Name:JIM P HUSSEY DOPA
Entity type:Organization
Organization Name:JIM P HUSSEY DOPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:PASCAL
Authorized Official - Last Name:HUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-234-8868
Mailing Address - Street 1:399 W CAMPBELL RD STE 204
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3606
Mailing Address - Country:US
Mailing Address - Phone:972-234-8868
Mailing Address - Fax:972-234-8466
Practice Address - Street 1:399 W CAMPBELL RD STE 204
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3606
Practice Address - Country:US
Practice Address - Phone:972-234-8868
Practice Address - Fax:972-234-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B30KMedicare PIN
TXD72480Medicare UPIN