Provider Demographics
NPI:1679776959
Name:RISDEN, JAN S (MD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:S
Last Name:RISDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9101 LBJ FWY
Mailing Address - Street 2:SUITE 710
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2057
Mailing Address - Country:US
Mailing Address - Phone:972-792-5700
Mailing Address - Fax:214-349-7707
Practice Address - Street 1:399 W CAMPBELL RD
Practice Address - Street 2:MEDICAL PLAZA II, SUITE 410
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3595
Practice Address - Country:US
Practice Address - Phone:972-238-7799
Practice Address - Fax:972-238-7135
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM5492207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BJ292OtherBCBS
TX189247301Medicaid
TX189247304Medicaid
TX189247306Medicaid
TX613337OtherMEDICARE PTAN
TX189247307Medicaid
TX189247302Medicaid
TX189247303Medicaid