Basic Information
| Provider Information | |||||||||
| NPI: | 1003062035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERRER | ||||||||
| FirstName: | JEANETTE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5656 KELLEY ST | ||||||||
| Address2: | LBJ INTERNAL MEDICINE- PALLIATIVE MED UT ANNEX 121 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770261967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135006295 | ||||||||
| FaxNumber: | 7135000706 | ||||||||
| Practice Location | |||||||||
| Address1: | 5656 KELLEY ST | ||||||||
| Address2: | LBJ INTERNAL MEDICINE- PALLIATIVE MED UT ANNEX 121 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770261967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135006295 | ||||||||
| FaxNumber: | 7135000706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2008 | ||||||||
| LastUpdateDate: | 08/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | BP1-0029050 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QH0002X | N7257 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | BP1-0029050 | 01 | TX | TEXAS PIT LICENSE NUMBER | OTHER |