Provider Demographics
NPI:1700846201
Name:JUMALON, FERNANDO M (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:M
Last Name:JUMALON
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 1:4423 GRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2815
Mailing Address - Country:US
Mailing Address - Phone:713-429-0655
Mailing Address - Fax:713-429-0670
Practice Address - Street 1:4423 GRIGGS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2815
Practice Address - Country:US
Practice Address - Phone:713-429-0655
Practice Address - Fax:713-429-0670
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM50459538Medicaid
NM50459538Medicaid
G79286Medicare UPIN