Basic Information
| Provider Information | |||||||||
| NPI: | 1912904079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELO | ||||||||
| FirstName: | JAIRO | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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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: | 07/05/2005 | ||||||||
| LastUpdateDate: | 10/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | K1260 | TX | N | Other Service Providers | Specialist | 207RP1001X | K1260 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 8AW555 | 01 | TX | BLUE CROSS | OTHER | 047531103 | 05 | TX | MEDICAID |