Provider Demographics
NPI:1235420878
Name:MALDONADO, CESAR ALFREDO (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:ALFREDO
Last Name:MALDONADO
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 1:1013A S WELLS ST
Mailing Address - Street 2:
Mailing Address - City:EDNA
Mailing Address - State:TX
Mailing Address - Zip Code:77957-4045
Mailing Address - Country:US
Mailing Address - Phone:361-782-7820
Mailing Address - Fax:361-782-5627
Practice Address - Street 1:1013A S WELLS ST
Practice Address - Street 2:
Practice Address - City:EDNA
Practice Address - State:TX
Practice Address - Zip Code:77957-4045
Practice Address - Country:US
Practice Address - Phone:361-782-7820
Practice Address - Fax:361-782-5627
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-01
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10039478207Q00000X
TXQ1664207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341143103Medicaid
TX00U54JMedicare UPIN