Provider Demographics
NPI:1972881100
Name:THORNS, JANTZEN DEANDRE I (MD)
Entity type:Individual
Prefix:DR
First Name:JANTZEN
Middle Name:DEANDRE
Last Name:THORNS
Suffix:I
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 1:20207 CHASEWOOD PARK DR STE 305
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1442
Mailing Address - Country:US
Mailing Address - Phone:832-534-7600
Mailing Address - Fax:
Practice Address - Street 1:20207 CHASEWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1441
Practice Address - Country:US
Practice Address - Phone:832-534-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0511208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX364955002Medicaid