Provider Demographics
NPI:1427119940
Name:UNDERWOOD, JAMES G (BC HIS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:G
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:BC HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:612-351-1529
Mailing Address - Fax:
Practice Address - Street 1:3800 SPENCER HWY STE P
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1250
Practice Address - Country:US
Practice Address - Phone:713-477-4835
Practice Address - Fax:713-477-4276
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50162237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
531042OtherBLUE CROSS BLUE SHIELD
6655037OtherCIGNA
TX022029501Medicaid