MEDICARE: JOSE MEDRANO M.D.

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	207L00000X	Anesthesiology Physician	D8575	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8L8930	OTHER	TX	MEDICARE PTAN

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

General Provider Information

NPI Number	:	1700816956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE MEDRANO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 19370
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77224-9370
Country	:	US
Telephone Number	:	832-237-9400
Fax Number	:	832-237-9411

Provider Business Practice Location Address
First Line	:	11037 FM 1960 RD W
Second Line	:	SUITE B1
City	:	HOUSTON
State	:	TX
Zip	:	77065-3600
Country	:	US
Telephone Number	:	832-237-9400
Fax Number	:	832-237-9411

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/17/2011

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Directions to “ JOSE MEDRANO M.D.” Practice Location

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