Provider Demographics
NPI:1255385605
Name:NARANJO, JESUS J (MD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:J
Last Name:NARANJO
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 1:8711 VILLAGE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5419
Mailing Address - Country:US
Mailing Address - Phone:210-541-8689
Mailing Address - Fax:210-541-8691
Practice Address - Street 1:2211 NW MILITARY HWY
Practice Address - Street 2:SUITE #201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1859
Practice Address - Country:US
Practice Address - Phone:210-696-2264
Practice Address - Fax:855-278-4555
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH3593OtherTX LICENSE
P01465709OtherRAILROAD MEDICARE
TXH3593OtherTX LICENSE
TX104558506Medicaid
TX104558506Medicaid