Provider Demographics
NPI:1093885782
Name:JEAN-MICHEL, MARIE JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE JOSE
Middle Name:
Last Name:JEAN-MICHEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E NOLANA AVE STE 13A
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6112
Mailing Address - Country:US
Mailing Address - Phone:956-686-2700
Mailing Address - Fax:956-686-2708
Practice Address - Street 1:801 E NOLANA AVE STE 13A
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6112
Practice Address - Country:US
Practice Address - Phone:956-686-2700
Practice Address - Fax:956-686-2708
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2352208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154593105Medicaid
NY01859594Medicaid
TX154593104Medicaid
TX154593105Medicaid