MEDICARE: DR. JENNIFER WEN DOE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	25MA08410300	NJ
2	2085R0202X	Diagnostic Radiology Physician	P2980	TX

General Provider Information

NPI Number	:	1770761009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER WEN DOE MD

Provider Business Mailing Address
First Line	:	4620 N BRAESWOOD BLVD
Second Line	:	APT 416
City	:	HOUSTON
State	:	TX
Zip	:	77096-2845
Country	:	US
Telephone Number	:	315-323-0236
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 W HOLCOMBE BLVD
Second Line	:	SUITE 102
City	:	HOUSTON
State	:	TX
Zip	:	77030-1934
Country	:	US
Telephone Number	:	832-804-8119
Fax Number	:	832-804-8120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	09/30/2013

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