MEDICARE: JOSE EMILIO DEJESUS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G9446	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	TXB121779	OTHER	TX	WELLMED MEDICAL GROUP PA

General Provider Information

NPI Number	:	1245237049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE EMILIO DEJESUS MD

Provider Business Mailing Address
First Line	:	8353 CULEBRA RD
Second Line	:	STE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-1902
Country	:	US
Telephone Number	:	210-706-2580
Fax Number	:	210-706-2582

Provider Business Practice Location Address
First Line	:	8353 CULEBRA RD
Second Line	:	STE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-1902
Country	:	US
Telephone Number	:	210-706-2580
Fax Number	:	210-706-2582

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/17/2016

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