MEDICARE: EDUARDO L JARAMILLO MD PA

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	207V00000X	Obstetrics & Gynecology Physician	M4204	TX

General Provider Information

NPI Number	:	1093048068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUARDO L JARAMILLO MD PA

Provider Business Mailing Address
First Line	:	2400 HIGHWAY 365 STE 207
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-6250
Country	:	US
Telephone Number	:	409-853-1882
Fax Number	:	409-722-0622

Provider Business Practice Location Address
First Line	:	2400 HIGHWAY 365 STE 207
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-6250
Country	:	US
Telephone Number	:	409-853-1882
Fax Number	:	409-722-0622

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. EDUARDO L JARAMILLO
Credential	:	MD
Telephone Number	:	409-853-1882

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	11/11/2009

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