Provider Demographics
NPI:1952720781
Name:MORENO, JAIME ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:ENRIQUE
Last Name:MORENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:ENRIQUE
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2455 NE LOOP 410 STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5650
Mailing Address - Country:US
Mailing Address - Phone:210-599-6000
Mailing Address - Fax:210-599-7519
Practice Address - Street 1:2455 NE LOOP 410 STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5650
Practice Address - Country:US
Practice Address - Phone:210-599-6000
Practice Address - Fax:210-599-7519
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine