Healthcare Provider Details

I. General information

NPI: 1750317186
Provider Name (Legal Business Name): TIJERINA UROLOGY CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 E AUSTIN ST
PARIS TX
75460-7353
US

IV. Provider business mailing address

811 E AUSTIN ST
PARIS TX
75460-7353
US

V. Phone/Fax

Practice location:
  • Phone: 903-785-0338
  • Fax: 903-785-5369
Mailing address:
  • Phone: 903-785-0338
  • Fax: 903-785-5369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JANE K TIJERINA
Title or Position: ADMINISTRATOR
Credential: APRN-C
Phone: 903-785-0338