Provider Demographics
NPI:1376873885
Name:JOSE V. IGLESIAS MD PA
Entity Type:Organization
Organization Name:JOSE V. IGLESIAS MD PA
Other - Org Name:PERIPHERAL VASCULAR CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:IGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-444-9400
Mailing Address - Street 1:17203 RED OAK DR STE 202
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2613
Mailing Address - Country:US
Mailing Address - Phone:281-444-9400
Mailing Address - Fax:
Practice Address - Street 1:17203 RED OAK DR STE 202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2613
Practice Address - Country:US
Practice Address - Phone:281-444-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC17289Medicare UPIN
TX0A5707Medicare PIN