Provider Demographics
NPI:1568650091
Name:MATOS, JESUS MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:MANUEL
Last Name:MATOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:718 LEXINGTON AVE.,
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1204
Mailing Address - Country:US
Mailing Address - Phone:210-420-8671
Mailing Address - Fax:210-899-1958
Practice Address - Street 1:718 LEXINGTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4790
Practice Address - Country:US
Practice Address - Phone:210-420-8671
Practice Address - Fax:210-899-1958
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP11052086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX343603205Medicaid
TX8FG323OtherBCBSTX - PVA
TX343603205Medicaid