Individual
JASMINE PETTIFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
25553 US HIGHWAY 59, PORTER, TX 77365-5500
(713) 442-2100
Mailing address
11511 SHADOW CREEK PKWY, PEARLAND, TX 77584-7298
(713) 442-0000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
S2874
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
402630401
—
TX
05
—
402630402
—
TX
Enumeration date
07/12/2016
Last updated
06/15/2021
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