Provider Demographics
NPI:1275764862
Name:JURADO, SAMUEL L JR (PA)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:L
Last Name:JURADO
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-6737
Mailing Address - Country:US
Mailing Address - Phone:806-293-8561
Mailing Address - Fax:806-293-7354
Practice Address - Street 1:2601 DIMMITT RD
Practice Address - Street 2:102
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-1833
Practice Address - Country:US
Practice Address - Phone:806-293-8561
Practice Address - Fax:806-293-7354
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209443501Medicaid
TX135077903Medicaid
805N46OtherBCBS TEXAS
805N46OtherBCBS TEXAS
TX8L17639Medicare PIN