Basic Information
| Provider Information | |||||||||
| NPI: | 1073792735 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAIRO A. MELO, M.D., P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 SPURS LN | ||||||||
| Address2: | SUITE 230B | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106907400 | ||||||||
| FaxNumber: | 2109576956 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 SPURS LN | ||||||||
| Address2: | SUITE 230B | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106907400 | ||||||||
| FaxNumber: | 2109576956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2007 | ||||||||
| LastUpdateDate: | 10/12/2011 | ||||||||
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| AuthorizedOfficialLastName: | CARDENAS | ||||||||
| AuthorizedOfficialFirstName: | BELINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2106907400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | K1260 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 174140701 | 05 | TX | MEDICAID | 0013RF | 01 | TX | BLUE CROSS | OTHER |