Provider Demographics
NPI:1164729638
Name:HECTOR MARTIN MALDONADO, M.D.,PH.D.,P.A.
Entity Type:Organization
Organization Name:HECTOR MARTIN MALDONADO, M.D.,PH.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:915-544-6262
Mailing Address - Street 1:3260 N MESA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2323
Mailing Address - Country:US
Mailing Address - Phone:915-544-6262
Mailing Address - Fax:915-544-6298
Practice Address - Street 1:3260 N MESA ST
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2323
Practice Address - Country:US
Practice Address - Phone:915-544-6262
Practice Address - Fax:915-544-6298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ00882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126438403Medicaid
TX178092700OtherWORKERS COMPENSATION
NMU3989Medicaid
TX=========799020000OtherTRICARE
TXF03010Medicare UPIN
TX=========799020000OtherTRICARE