Provider Demographics
NPI:1124069406
Name:VALDES, NORA I (MD)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:I
Last Name:VALDES
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 1:4903 GOLDEN QUAIL
Mailing Address - Street 2:STE 114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1585
Mailing Address - Country:US
Mailing Address - Phone:210-614-0000
Mailing Address - Fax:210-641-2441
Practice Address - Street 1:5282 MEDICAL DR
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6114
Practice Address - Country:US
Practice Address - Phone:210-614-0000
Practice Address - Fax:210-614-0372
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK9444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039342302Medicaid
7832OtherCOMMUNITY FIRST
10061825OtherAMERIGROUP
5342OtherAETNA MEDICAID
TX0045KHOtherBLUE CROSS BLUE SHIELD
TX159973001Medicaid
717857OtherUPMC
7517144OtherAETNA
TX0045KHOtherBLUE CROSS BLUE SHIELD
TX00621VMedicare ID - Type UnspecifiedGROUP MEDICARE ID
TXG77882Medicare UPIN