Provider Demographics
NPI:1992923569
Name:REKOFF, JEAN GREGORY JR (NP)
Entity type:Individual
Prefix:MR
First Name:JEAN
Middle Name:GREGORY
Last Name:REKOFF
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6410 FANNIN ST
Mailing Address - Street 2:SUITE 722
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3000
Mailing Address - Country:US
Mailing Address - Phone:832-325-7284
Mailing Address - Fax:713-512-7140
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:SUITE 722
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:832-325-7284
Practice Address - Fax:713-512-7140
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-21
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564031363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180530102Medicaid
TXDF1985OtherMEDICARE RR GROUP
TX0095PVOtherBC/BS
TX00933YMedicare PIN
TX180530102Medicaid