Healthcare Provider Details

I. General information

NPI: 1568760403
Provider Name (Legal Business Name): JAYDAM SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 WESTPARK DR 321
HOUSTON TX
77057-7322
US

IV. Provider business mailing address

6250 WESTPARK DR 321
HOUSTON TX
77057-7322
US

V. Phone/Fax

Practice location:
  • Phone: 832-723-2549
  • Fax:
Mailing address:
  • Phone: 832-723-2549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. YVONNE D DOHERTY
Title or Position: ADMINISTRATOR
Credential:
Phone: 832-723-2549