Provider Demographics
NPI:1538372156
Name:JAMES, JENNIFER SONIA (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SONIA
Last Name:JAMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:M/C 18
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-857-1710
Mailing Address - Fax:214-857-1712
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:M/C 18
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-1710
Practice Address - Fax:214-857-1712
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2661207QG0300X
IL36116041207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188447001Medicaid
TX188447001Medicaid