Provider Demographics
NPI:1386620656
Name:NUSBAUM, JEAN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:NUSBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13601 PRESTON RD
Mailing Address - Street 2:SUITE 900W
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4911
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-386-4292
Practice Address - Street 1:4343 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4603
Practice Address - Country:US
Practice Address - Phone:972-394-2412
Practice Address - Fax:972-394-2328
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL0464207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D8007Medicare ID - Type Unspecified339K
H27150Medicare UPIN
TX8D8006Medicare ID - Type Unspecified606K