Provider Demographics
NPI:1457369050
Name:MALDONADO, HECTOR MARTIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:MARTIN
Last Name:MALDONADO
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 1:3260 N MESA ST STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2323
Mailing Address - Country:US
Mailing Address - Phone:915-544-6262
Mailing Address - Fax:915-544-6298
Practice Address - Street 1:3260 N MESA ST STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2323
Practice Address - Country:US
Practice Address - Phone:915-544-6262
Practice Address - Fax:915-544-6298
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ00882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMU3989Medicaid
TX00K06TOtherBC/BS OF TEXAS
742901145799020000OtherCHAMPUS
TXJ0088OtherMEDICAL LICENSE
TXJ0088OtherMEDICAL LICENSE
TX00K06TMedicare PIN