Provider Demographics
NPI:1609057074
Name:OLMEDO, PABLO DE JESUS (MD)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:DE JESUS
Last Name:OLMEDO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1400 W TRENTON RD
Mailing Address - Street 2:ATTTN: PHYSICIAN PRACTICE ADMINISTRATOR
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3413
Mailing Address - Country:US
Mailing Address - Phone:956-388-2207
Mailing Address - Fax:956-289-5040
Practice Address - Street 1:1102 W TRENTON RD
Practice Address - Street 2:ATTTN: MCALLEN HOSPITALIST PROGRAM
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9105
Practice Address - Country:US
Practice Address - Phone:956-213-5111
Practice Address - Fax:956-289-5040
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2014-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM8225207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202365703Medicaid
TX202365703Medicaid