Healthcare Provider Details

I. General information

NPI: 1316333552
Provider Name (Legal Business Name): JAMON BLOOD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11937 US HIGHWAY 271
TYLER TX
75708-3154
US

IV. Provider business mailing address

11937 US HIGHWAY 271
TYLER TX
75708-3154
US

V. Phone/Fax

Practice location:
  • Phone: 39-877-7168
  • Fax: 903-877-8355
Mailing address:
  • Phone: 39-877-7168
  • Fax: 903-877-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberR8158
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: