Provider Demographics
NPI:1154348936
Name:BARAJAZ, MICHELLE DEAN (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DEAN
Last Name:BARAJAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MICHELLE DEAN
Other - Last Name:BARAJAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:333 N SANTA ROSA ST
Mailing Address - Street 2:SUITE F3725
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3108
Mailing Address - Country:US
Mailing Address - Phone:210-704-3039
Mailing Address - Fax:210-704-4922
Practice Address - Street 1:333 N SANTA ROSA ST
Practice Address - Street 2:SUITE F3725
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3108
Practice Address - Country:US
Practice Address - Phone:210-704-3039
Practice Address - Fax:210-704-4922
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200646208000000X
TXK9721208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DA264OtherBCBS
TX191887202Medicaid
LA1356841Medicaid
LA4K013F600Medicare PIN
LAH77936Medicare UPIN
TXTXB140689Medicare PIN