Individual
RICHARD D JELSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
425 N HIGHLAND AVE, SUITE 110, SHERMAN, TX 75092-7377
(903) 868-8800
(903) 868-4405
Mailing address
425 N HIGHLAND AVE, SUITE 110, SHERMAN, TX 75092-7377
(903) 868-8800
(903) 868-4405
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J8284
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100126503
—
TX
01
—
200046278
RAILROAD MEDICARE PTAN
TX
01
—
8AW412
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/19/2005
Last updated
05/01/2008
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