Provider Demographics
NPI:1174584452
Name:WASSERSTEIN, JEROME CHARLES (DO)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:CHARLES
Last Name:WASSERSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JEROME
Other - Middle Name:C
Other - Last Name:WASSERSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:4545 POST OAK PLACE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3164
Mailing Address - Country:US
Mailing Address - Phone:713-960-8008
Mailing Address - Fax:
Practice Address - Street 1:4545 POST OAK PLACE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3164
Practice Address - Country:US
Practice Address - Phone:713-960-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3619207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00087AP8Medicaid
TX133441902Medicaid
TXP00087AP8Medicaid
TXD97816Medicare UPIN