Provider Demographics
NPI:1053303255
Name:VALLADARES, JOSE LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:VALLADARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E SAN ANTONIO ST STE 310E
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6053
Mailing Address - Country:US
Mailing Address - Phone:361-485-9600
Mailing Address - Fax:
Practice Address - Street 1:605 E SAN ANTONIO ST STE 310E
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6053
Practice Address - Country:US
Practice Address - Phone:361-485-9600
Practice Address - Fax:361-485-9610
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.096247207RH0003X
TXL5595207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L20504Medicare PIN
H80935Medicare UPIN
TX00115WMedicare PIN