Provider Demographics
NPI:1063515161
Name:MEDRANO, JUAN CARLOS (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:CARLOS
Other - Last Name:MEDRANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7400 FANNIN ST.
Mailing Address - Street 2:SUITE 800
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1935
Mailing Address - Country:US
Mailing Address - Phone:713-797-1100
Mailing Address - Fax:713-797-9757
Practice Address - Street 1:7400 FANNIN ST.
Practice Address - Street 2:SUITE 800
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1935
Practice Address - Country:US
Practice Address - Phone:713-797-1100
Practice Address - Fax:713-797-9757
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF-2803207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00723224OtherRAILROAD MEDICARE
TX034908601Medicaid
TX034908602Medicaid
TX034908602Medicaid
TX034908601Medicaid
TX00MP37Medicare ID - Type Unspecified