Provider Demographics
NPI:1629035423
Name:MEDRANO, JAIME (MD)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:MEDRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:415 S. AIRPORT SUITE E
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-973-5024
Mailing Address - Fax:956-973-5064
Practice Address - Street 1:415 S. AIRPORT SUITE E
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596
Practice Address - Country:US
Practice Address - Phone:956-973-5024
Practice Address - Fax:956-973-5064
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX03.7773102Medicaid
TXK1873OtherTEXAS PHYSICIAN PERMIT