MEDICARE: DR. WILMER VALENTIN 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	208600000X	Surgery Physician	BP10046926	TX
2	208D00000X	General Practice Physician	Q6914	TX

General Provider Information

NPI Number	:	1174960967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILMER VALENTIN M.D.

Provider Business Mailing Address
First Line	:	24540 FM 1314 RD
Second Line	:
City	:	PORTER
State	:	TX
Zip	:	77365-4204
Country	:	US
Telephone Number	:	281-354-4009
Fax Number	:

Provider Business Practice Location Address
First Line	:	24540 FM 1314 RD
Second Line	:
City	:	PORTER
State	:	TX
Zip	:	77365-4204
Country	:	US
Telephone Number	:	281-354-4009
Fax Number	:

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

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	02/18/2019

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