Provider Demographics
NPI:1982681946
Name:ENSLEIN, JEREMY G (DO)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:G
Last Name:ENSLEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E RIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1506
Mailing Address - Country:US
Mailing Address - Phone:956-630-5522
Mailing Address - Fax:956-926-4350
Practice Address - Street 1:500 E RIDGE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1506
Practice Address - Country:US
Practice Address - Phone:956-630-5522
Practice Address - Fax:956-926-4350
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0793207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M5101OtherBCBS
TX177005901Medicaid
TX8M5101OtherBCBS OF TX
TX8M5101OtherBCBS
TX8G0479Medicare PIN
TX8G0479Medicare ID - Type Unspecified