Provider Demographics
NPI:1083793087
Name:MAEDA, JOSE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:MAEDA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1215
Mailing Address - Street 2:ATTN CLINIC BILLING OFFICE
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-1215
Mailing Address - Country:US
Mailing Address - Phone:620-629-6638
Mailing Address - Fax:620-629-6684
Practice Address - Street 1:305 W 15TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2455
Practice Address - Country:US
Practice Address - Phone:620-624-4946
Practice Address - Fax:620-624-2260
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2017-03-08
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Provider Licenses
StateLicense IDTaxonomies
TXJ1719208600000X
KS0436164208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200554440AMedicaid
KS201001320AMedicaid
KS201001320AMedicaid