MEDICARE: HECTOR 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
1	174400000X	Specialist	D5558	TX

General Provider Information

NPI Number	:	1295707511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HECTOR MEDELLIN M.D.

Provider Business Mailing Address
First Line	:	9601 KATY FWY
Second Line	:	STE. 315
City	:	HOUSTON
State	:	TX
Zip	:	77024-1342
Country	:	US
Telephone Number	:	713-547-5786
Fax Number	:	713-467-6881

Provider Business Practice Location Address
First Line	:	9601 KATY FWY
Second Line	:	STE. 315
City	:	HOUSTON
State	:	TX
Zip	:	77024-1342
Country	:	US
Telephone Number	:	713-547-5786
Fax Number	:	713-467-6881

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	05/05/2011

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