Provider Demographics
NPI:1902385453
Name:JAIME MEDRANO MD PA
Entity Type:Organization
Organization Name:JAIME MEDRANO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-973-5024
Mailing Address - Street 1:415 S AIRPORT DR STE E
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5396
Mailing Address - Country:US
Mailing Address - Phone:956-973-5024
Mailing Address - Fax:956-973-5064
Practice Address - Street 1:415 S AIRPORT DR STE E
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5396
Practice Address - Country:US
Practice Address - Phone:956-973-5024
Practice Address - Fax:956-973-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1629035423OtherNPI
TX03-7773102Medicaid
K1873OtherTEXAS PHYSICIAN PERMIT