Provider Demographics
NPI:1417299538
Name:MEDINA, MICHAEL JOE
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOE
Last Name:MEDINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD # 2-A
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0591
Mailing Address - Country:US
Mailing Address - Phone:409-772-1221
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD # 2-A
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0591
Practice Address - Country:US
Practice Address - Phone:409-772-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3912207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine