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NPI Code Detail

MEDICARE: DR. JEROME CHARLES WASSERSTEIN D.O.

MEDICARE: DR. JEROME CHARLES WASSERSTEIN D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QG0300XGeriatric Medicine (Family Medicine) PhysicianE3619TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174584452
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEROME CHARLES WASSERSTEIN D.O.
Provider Business Mailing Address
First Line : 4545 POST OAK PLACE DR
Second Line : SUITE 130
City : HOUSTON
State : TX
Zip : 77027-3164
Country : US
Telephone Number : 713-960-8008
Fax Number :
Provider Business Practice Location Address
First Line : 4545 POST OAK PLACE DR
Second Line : SUITE 130
City : HOUSTON
State : TX
Zip : 77027-3164
Country : US
Telephone Number : 713-960-8008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2006
Last Update Date : 02/08/2016

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