Provider Demographics
NPI:1922716794
Name:VASCONCELLOS MARADEI, JEFERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFERSON
Middle Name:
Last Name:VASCONCELLOS MARADEI
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 1:413 UMAR AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-1972
Mailing Address - Country:US
Mailing Address - Phone:210-322-6792
Mailing Address - Fax:
Practice Address - Street 1:23103 IH 10 W STE 111
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1766
Practice Address - Country:US
Practice Address - Phone:210-571-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDING208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery