Provider Demographics
NPI:1205046752
Name:SQUARE, JAIME HOLBERTON (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:HOLBERTON
Last Name:SQUARE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 961783
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79996-1783
Mailing Address - Country:US
Mailing Address - Phone:915-777-3151
Mailing Address - Fax:915-855-6111
Practice Address - Street 1:11880 VISTA DEL SOL DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6128
Practice Address - Country:US
Practice Address - Phone:915-777-3151
Practice Address - Fax:915-855-6111
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM7650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193400204Medicaid
TX193400201Medicaid