Healthcare Provider Details

I. General information

NPI: 1043317514
Provider Name (Legal Business Name): JEP CARDIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 WEST DAVIS STREET SUITE 220
CONROE TX
77304
US

IV. Provider business mailing address

119 NORTH SUMMER CLOUD DRIVE
THE WOODLANDS TX
77381-6225
US

V. Phone/Fax

Practice location:
  • Phone: 936-760-1691
  • Fax:
Mailing address:
  • Phone: 281-989-9910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberL 1430
License Number StateTX

VIII. Authorized Official

Name: DR. JOHN EDWARD PERRY III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 936-760-1691