Provider Demographics
NPI:1699777110
Name:WOLENS, JEOFFREY K (MD)
Entity type:Individual
Prefix:DR
First Name:JEOFFREY
Middle Name:K
Last Name:WOLENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2727 GRAMERCY ST
Mailing Address - Street 2:SUITE #225
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1633
Mailing Address - Country:US
Mailing Address - Phone:713-665-4567
Mailing Address - Fax:713-665-8962
Practice Address - Street 1:2727 GRAMERCY ST
Practice Address - Street 2:SUITE #225
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1633
Practice Address - Country:US
Practice Address - Phone:713-665-4567
Practice Address - Fax:713-665-8962
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK3536208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
00W311Medicare ID - Type UnspecifiedMEDICARE GROUP AND IND #
TXG65448Medicare UPIN