MEDICARE: JAMIE CALVIN

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363AM0700X	Medical Physician Assistant	PA12466	TX

General Provider Information

NPI Number	:	1871070458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE CALVIN

Provider Business Mailing Address
First Line	:	13262 AUTUMN MIST LN
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77302-3547
Country	:	US
Telephone Number	:	979-777-4791
Fax Number	:

Provider Business Practice Location Address
First Line	:	6777 WOODLANDS PKWY STE 300
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77382-2785
Country	:	US
Telephone Number	:	281-429-8698
Fax Number	:

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

Provider Enumeration Date	:	07/26/2018
Last Update Date	:	03/03/2023

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Directions to “ JAMIE CALVIN ” Practice Location

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