Provider Demographics
NPI:1902880487
Name:JUAN A MALDONADO MD PA
Entity Type:Organization
Organization Name:JUAN A MALDONADO MD PA
Other - Org Name:JUAN A MALDONADO MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-423-9111
Mailing Address - Street 1:2106 HALE AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8408
Mailing Address - Country:US
Mailing Address - Phone:956-423-9111
Mailing Address - Fax:956-423-9273
Practice Address - Street 1:2106 HALE AVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8408
Practice Address - Country:US
Practice Address - Phone:956-423-9111
Practice Address - Fax:956-423-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0132PUOtherBLUE CROSS/BLUE SHIELD
TX00670ZMedicare PIN