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NPI Code Detail

MEDICARE: DR. ROLAND A MEDELLIN M.D.

MEDICARE: DR. ROLAND A MEDELLIN 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
1207Q00000XFamily Medicine PhysicianH9467TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1H9467OTHERTXTEXAS STATE LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184626871
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROLAND A MEDELLIN M.D.
Provider Business Mailing Address
First Line : 228 SAINT GEORGE ST
Second Line :
City : GONZALES
State : TX
Zip : 78629-3910
Country : US
Telephone Number : 830-672-6511
Fax Number : 830-672-6430
Provider Business Practice Location Address
First Line : 228 SAINT GEORGE ST
Second Line :
City : GONZALES
State : TX
Zip : 78629-3910
Country : US
Telephone Number : 830-672-6511
Fax Number : 830-672-6430
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 08/04/2014

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