Provider Demographics
NPI:1447396015
Name:VALLEJO-MANZUR, JOSE FEDERICO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:FEDERICO
Last Name:VALLEJO-MANZUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6148
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-6148
Mailing Address - Country:US
Mailing Address - Phone:956-362-8677
Mailing Address - Fax:956-362-7253
Practice Address - Street 1:5300 N G ST STE 110
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6550
Practice Address - Country:US
Practice Address - Phone:956-540-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2328207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L13504Medicare PIN