Provider Demographics
NPI:1508817206
Name:MANDUJANO, JOSE FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:FERNANDO
Last Name:MANDUJANO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8501 WADE BLVD
Mailing Address - Street 2:BLDG. X, SUITE 1020
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5894
Mailing Address - Country:US
Mailing Address - Phone:972-668-5864
Mailing Address - Fax:972-668-5825
Practice Address - Street 1:8501 WADE BLVD
Practice Address - Street 2:BLDG. X, SUITE 1020
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5894
Practice Address - Country:US
Practice Address - Phone:972-668-5864
Practice Address - Fax:972-668-5825
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
174400000X
TXK33202080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081278601Medicaid
TX081278601Medicaid