Provider Demographics
NPI:1235184821
Name:FUENTES, JOSE ARMONDO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ARMONDO
Last Name:FUENTES
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:PO BOX 226656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-6656
Mailing Address - Country:US
Mailing Address - Phone:214-943-9431
Mailing Address - Fax:214-943-9407
Practice Address - Street 1:214 W COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2326
Practice Address - Country:US
Practice Address - Phone:214-943-9431
Practice Address - Fax:214-943-9407
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1557208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123008806Medicaid
TX123008805Medicaid
TX8F7939OtherBCBS
TX123008806Medicaid
TX8G5757Medicare PIN
TX8G5756Medicare PIN
TX123008805Medicaid