Individual
DR. JAIME MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1715 MCCULLOUGH AVE, SAN ANTONIO, TX 78212
(210) 225-5323
(210) 225-7505
Mailing address
1715 MCCULLOUGH AVE, SAN ANTONIO, TX 78212
(210) 225-5323
(210) 225-7505
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G8298
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1146664-09
WELLMED MEDICAID
TX
01
—
TXB145160
WELLMED MEDICAL GROUP, PA
TX
Enumeration date
03/28/2006
Last updated
01/27/2021
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