Provider Demographics
NPI:1295727204
Name:MEDRANO, CARLOS J (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:J
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3945
Mailing Address - Country:US
Mailing Address - Phone:956-380-1911
Mailing Address - Fax:956-380-1913
Practice Address - Street 1:304 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3945
Practice Address - Country:US
Practice Address - Phone:956-380-1911
Practice Address - Fax:956-380-1913
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2011-12-29
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXK8662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine