Provider Demographics
NPI:1700816956
Name:MEDRANO, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:MEDRANO
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:PO BOX 19370
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77224-9370
Mailing Address - Country:US
Mailing Address - Phone:832-237-9400
Mailing Address - Fax:832-237-9411
Practice Address - Street 1:11037 FM 1960 RD W
Practice Address - Street 2:SUITE B1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3600
Practice Address - Country:US
Practice Address - Phone:832-237-9400
Practice Address - Fax:832-237-9411
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8575207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163095601Medicaid
TX8L8930OtherMEDICARE PTAN
TX8L8930OtherMEDICARE PTAN