Provider Demographics
NPI:1275544207
Name:ACEVES, JOSE L (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:ACEVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:315 N SAN SABA STE 1135
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3255
Mailing Address - Country:US
Mailing Address - Phone:210-704-4275
Mailing Address - Fax:210-704-4520
Practice Address - Street 1:333 N SANTA ROSA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3108
Practice Address - Country:US
Practice Address - Phone:210-704-4708
Practice Address - Fax:210-704-4952
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ77412084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092139706Medicaid
TX137345810Medicaid
TX124023OtherSUPERIOR PIN
TX8A9111OtherBCBSTX IND PIN
TX092139707Medicaid
TX5447047OtherCIGNA PIN
TX1833530OtherFIRSTHEALTH PIN
TX00U87ZOtherBCBSTX GRP PIN
TX7309076OtherAETNA PIN
TX10027042OtherAMERIGROUP PIN
TX1966795OtherUHC PIN
TX092139720Medicaid
TX130116100OtherFIRSTCARE PIN
TX140442852Medicaid
TX140442852Medicaid
TX092139707Medicaid