Provider Demographics
NPI:1700829918
Name:MOLINA, JURAIRAT J (MD)
Entity type:Individual
Prefix:MS
First Name:JURAIRAT
Middle Name:J
Last Name:MOLINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-5246
Mailing Address - Country:US
Mailing Address - Phone:512-732-2774
Mailing Address - Fax:
Practice Address - Street 1:525 OAK CENTRE DR STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3935
Practice Address - Country:US
Practice Address - Phone:210-494-0690
Practice Address - Fax:210-494-0920
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2478207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146814202Medicaid
TXL2478Medicare UPIN
TX0030Medicare ID - Type Unspecified
TX146814203Medicaid