MEDICARE: JEREMY G ENSLEIN DO

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	207RC0000X	Cardiovascular Disease Physician	L0793	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8M5101	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8M5101	OTHER	TX	BCBS OF TX

General Provider Information

NPI Number	:	1982681946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY G ENSLEIN DO

Provider Business Mailing Address
First Line	:	500 E RIDGE RD
Second Line	:	SUITE 100
City	:	MCALLEN
State	:	TX
Zip	:	78503-1506
Country	:	US
Telephone Number	:	956-630-5522
Fax Number	:	956-926-4350

Provider Business Practice Location Address
First Line	:	500 E RIDGE RD
Second Line	:	SUITE 300
City	:	MCALLEN
State	:	TX
Zip	:	78503-1506
Country	:	US
Telephone Number	:	956-630-5522
Fax Number	:	956-926-4350

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	01/13/2022

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