MEDICARE: JERISSA P BELSHA M.D.

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
1	208000000X	Pediatrics Physician	N1550	TX

General Provider Information

NPI Number	:	1730412065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERISSA P BELSHA M.D.

Provider Business Mailing Address
First Line	:	6769 LAKE WOODLANDS DR
Second Line	:	SUITE E
City	:	THE WOODLANDS
State	:	TX
Zip	:	77382-2770
Country	:	US
Telephone Number	:	281-210-1200
Fax Number	:	281-210-1210

Provider Business Practice Location Address
First Line	:	6769 LAKE WOODLANDS DR
Second Line	:	SUITE E
City	:	THE WOODLANDS
State	:	TX
Zip	:	77382-2770
Country	:	US
Telephone Number	:	281-210-1200
Fax Number	:	281-210-1210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2009
Last Update Date	:	12/11/2015

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