Provider Demographics
NPI:1417091919
Name:MALDONADO, JOSE ROEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ROEL
Last Name:MALDONADO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 452309
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0057
Mailing Address - Country:US
Mailing Address - Phone:956-791-8008
Mailing Address - Fax:956-791-8098
Practice Address - Street 1:6828 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2286
Practice Address - Country:US
Practice Address - Phone:956-791-8008
Practice Address - Fax:956-791-8098
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2012-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL8821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172009601Medicaid
TX172009601Medicaid
TX00950XMedicare ID - Type Unspecified