Provider Demographics
NPI:1790079929
Name:JARAMILLO, EDUARDO LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:LEON
Last Name:JARAMILLO
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 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-627-2409
Mailing Address - Fax:940-626-4579
Practice Address - Street 1:2451 S FM 51 STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3860
Practice Address - Country:US
Practice Address - Phone:940-627-2409
Practice Address - Fax:940-626-4579
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2908207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179009929Medicaid
TXPENDINGOtherBCBSTX