Basic Information
| Provider Information | |||||||||
| NPI: | 1477514826 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REFUERZO | ||||||||
| FirstName: | JERRIE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6700 WEST LOOP SOUTH, SUITE 420 | ||||||||
| Address2: | |||||||||
| City: | BELLAIRE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323257133 | ||||||||
| FaxNumber: | 7133831479 | ||||||||
| Practice Location | |||||||||
| Address1: | 6700 WEST LOOP SOUTH, SUITE 420 | ||||||||
| Address2: | |||||||||
| City: | BELLAIRE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323257133 | ||||||||
| FaxNumber: | 7133831479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 05/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | 4301068208 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VM0101X | FTL 41764 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VM0101X | M9605 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 188691301 | 05 | TX | MEDICAID | 8H3609 | 01 | TX | BCBS | OTHER | 4839787 | 05 | MI | MEDICAID |