Provider Demographics
NPI:1073792735
Name:JAIRO A. MELO, M.D., P.A.
Entity Type:Organization
Organization Name:JAIRO A. MELO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-690-7400
Mailing Address - Street 1:21 SPURS LN
Mailing Address - Street 2:SUITE 230B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1669
Mailing Address - Country:US
Mailing Address - Phone:210-690-7400
Mailing Address - Fax:210-957-6956
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:SUITE 230B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:210-690-7400
Practice Address - Fax:210-957-6956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1260207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174140701Medicaid
TX0013RFOtherBLUE CROSS
TX00766YMedicare PIN
TX174140701Medicaid