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General NPI Number Information
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NPI Number | 1861493231
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Entity Type | Individual
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Provider Name | JESUS D UCOL MD PA
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1718 10TH ST STE A
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City | WICHITA FALLS
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State | TX
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Zip | 76301-5053
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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 1718 10TH ST. SUITE A
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City | WICHITA FALLS
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State | TX
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Zip | 76308-0167
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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 |
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Name |
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Credential |
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Telephone |
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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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