MEDICARE: JOSE V. IGLESIAS 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	174400000X	Specialist	E1343	TX

General Provider Information

NPI Number	:	1376873885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE V. IGLESIAS MD PA

Provider Business Mailing Address
First Line	:	17203 RED OAK DR STE 202
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2613
Country	:	US
Telephone Number	:	281-444-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	17203 RED OAK DR STE 202
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2613
Country	:	US
Telephone Number	:	281-444-9400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSE VICTOR IGLESIAS
Credential	:	MD
Telephone Number	:	281-444-9400

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	10/04/2016

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