Provider Demographics
NPI:1245237049
Name:DEJESUS, JOSE EMILIO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:EMILIO
Last Name:DEJESUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8353 CULEBRA RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1902
Mailing Address - Country:US
Mailing Address - Phone:210-706-2580
Mailing Address - Fax:210-706-2582
Practice Address - Street 1:8353 CULEBRA RD
Practice Address - Street 2:STE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1902
Practice Address - Country:US
Practice Address - Phone:210-706-2580
Practice Address - Fax:210-706-2582
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG9446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1388381-14OtherWELLMED MEDICAID
TXTXB121779OtherWELLMED MEDICAL GROUP PA
B22153Medicare UPIN
8F6824Medicare PIN