Provider Demographics
NPI:1134179567
Name:MEJIA, JOSE W (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:W
Last Name:MEJIA
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 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5656 BEE CAVES RD STE M300
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5814
Practice Address - Country:US
Practice Address - Phone:512-807-3270
Practice Address - Fax:855-697-2500
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4348207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180896601Medicaid
TX8G6307Medicare PIN
TX180896601Medicaid
TXP00336250Medicare PIN