Provider Demographics
NPI:1457468647
Name:SERRANO, JUAN HERNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:HERNAN
Last Name:SERRANO
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 1:1200 BINZ ST STE 1195
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6900
Mailing Address - Country:US
Mailing Address - Phone:713-522-0680
Mailing Address - Fax:713-522-8985
Practice Address - Street 1:1200 BINZ ST STE 1195
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-522-0680
Practice Address - Fax:713-522-8985
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE-3766207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00AA58OtherBCBS TX
TX113966902Medicaid
TX00AA58Medicare PIN
TX00AA58OtherBCBS TX