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General NPI Number Information
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NPI Number | 1003908351
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Entity Type | Organization
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Legal Business Name | JESUS D UCOL MD PA
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1718 10TH ST SUITE A
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City | WICHITA FALLS
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State | TX
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Zip | 76301
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Country | US
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Telephone | 940-761-5437
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Fax | 940-761-5400
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Provider Business Mailing Address
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Address Line | PO BOX 4167
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City | WICHITA FALLS
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State | TX
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Zip | 76308
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Country | US
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Telephone | 940-761-5437
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Fax | 940-761-5400
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Authorized Official
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Title or Position | JESUS UCOL MD PA
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Name | JESUS D UCOL
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Credential | MD
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Telephone | 940-261-3437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | J9407
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License Number State | TX
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