Provider Demographics
NPI:1093717639
Name:MAYMI, JOSE LUIS (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:MAYMI
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 1:1719 TREASURE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8912
Mailing Address - Country:US
Mailing Address - Phone:956-554-4857
Mailing Address - Fax:956-546-1936
Practice Address - Street 1:844 CENTRAL BLVD
Practice Address - Street 2:SUITE 430
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7552
Practice Address - Country:US
Practice Address - Phone:956-554-4857
Practice Address - Fax:956-546-1936
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35617208800000X
TXM4331208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0438323Medicaid
TXM4331OtherMEDICAL LICENSE
IA35556OtherWELLMARK BCBS
TX183260204Medicaid
TX183260203Medicaid
TXTXB109863Medicare PIN
TX8L15448Medicare PIN
TX183260204Medicaid
TXM4331OtherMEDICAL LICENSE