Provider Demographics
NPI:1558437012
Name:VALDES, JESUS A (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:A
Last Name:VALDES
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 1:4402 VANCE JACKSON
Mailing Address - Street 2:SUITE 248
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230
Mailing Address - Country:US
Mailing Address - Phone:210-344-9988
Mailing Address - Fax:210-344-0651
Practice Address - Street 1:4402 VANCE JACKSON
Practice Address - Street 2:SUITE 248
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230
Practice Address - Country:US
Practice Address - Phone:210-344-9988
Practice Address - Fax:210-344-0651
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX67363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112100602Medicaid
TXFS62OtherBLUE CROSS BLUE SHIELD
TXFS62OtherBLUE CROSS BLUE SHIELD
TX112100602Medicaid