Provider Demographics
NPI:1194839530
Name:MIRAVITE, JAIME VINLUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:VINLUAN
Last Name:MIRAVITE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1901 POST OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-3867
Mailing Address - Country:US
Mailing Address - Phone:936-321-2051
Mailing Address - Fax:936-321-2051
Practice Address - Street 1:1313 HERMANN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7005
Practice Address - Country:US
Practice Address - Phone:713-527-5000
Practice Address - Fax:214-712-2487
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK1565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F74481Medicare UPIN