Provider Demographics
NPI:1134393234
Name:EDUARDO M. DE JESUS, M.D., P.A.
Entity type:Organization
Organization Name:EDUARDO M. DE JESUS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-607-4625
Mailing Address - Street 1:5746 TROWBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3341
Mailing Address - Country:US
Mailing Address - Phone:915-219-4300
Mailing Address - Fax:915-519-4300
Practice Address - Street 1:7812 GATEWAY BLVD E
Practice Address - Street 2:SUITE 230
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1802
Practice Address - Country:US
Practice Address - Phone:915-592-8223
Practice Address - Fax:915-592-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X
TXJ8988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0068RFOtherBLUE CROSS AND BLUE SHIELD OF TEXAS
TX196521203Medicaid
TXDN7782OtherMEDICARE RAILROAD
TX196521203Medicaid
TX0068RFOtherBLUE CROSS AND BLUE SHIELD OF TEXAS