Provider Demographics
NPI:1487072062
Name:UNDERWOOD, JENNY L (MD)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:L
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19502 ROCKVIEW LEDGE LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7734
Mailing Address - Country:US
Mailing Address - Phone:786-342-5976
Mailing Address - Fax:
Practice Address - Street 1:102 15TH ST NW STE 301
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1627
Practice Address - Country:US
Practice Address - Phone:764-391-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96045207V00000X
VA0101267233207V00000X
PAMD480130207V00000X
FLME165721207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology