Provider Demographics
NPI:1235105651
Name:ARELLANO, JOSE B (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:B
Last Name:ARELLANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 732973
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-2973
Mailing Address - Country:US
Mailing Address - Phone:817-927-1255
Mailing Address - Fax:817-927-1405
Practice Address - Street 1:1500 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4917
Practice Address - Country:US
Practice Address - Phone:817-927-1255
Practice Address - Fax:817-927-1405
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH38502080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX489552ZUHKMedicare PIN
TXE36408Medicare UPIN