Healthcare Provider Details

I. General information

NPI: 1114102092
Provider Name (Legal Business Name): AYESHA JAMAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 W UNIVERSITY DR
MCKINNEY TX
75071-7822
US

IV. Provider business mailing address

3504 SPRINGBRANCH DR
RICHARDSON TX
75082-2430
US

V. Phone/Fax

Practice location:
  • Phone: 469-764-6950
  • Fax:
Mailing address:
  • Phone: 972-268-0591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA101850
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0067373
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN2580
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: