Provider Demographics
NPI:1366460479
Name:HAVEMANN, JAMES FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FREDERICK
Last Name:HAVEMANN
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 1:1280 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7509
Mailing Address - Country:US
Mailing Address - Phone:469-495-9018
Mailing Address - Fax:
Practice Address - Street 1:1280 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7509
Practice Address - Country:US
Practice Address - Phone:469-495-9018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166615801Medicaid
TX8K0333OtherBCBS
TX8K0333OtherBCBS
TX8B6407Medicare PIN