MEDICARE: JEFFEEA NICOLE GULLETT M.D

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	207R00000X	Internal Medicine Physician	P9362	TX

General Provider Information

NPI Number	:	1790032555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFEEA NICOLE GULLETT M.D

Provider Business Mailing Address
First Line	:	7364 ANTOINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-7230
Country	:	US
Telephone Number	:	713-486-7350
Fax Number	:

Provider Business Practice Location Address
First Line	:	7364 ANTOINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-7230
Country	:	US
Telephone Number	:	713-486-7350
Fax Number	:

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

Provider Enumeration Date	:	08/12/2012
Last Update Date	:	05/03/2016

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