Individual
IVAN A MEDEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1710 E SAUNDERS ST, SUITE B-375, LAREDO, TX 78041-5443
(956) 795-8297
(956) 794-8888
Mailing address
PO BOX 450748, LAREDO, TX 78045-0018
(956) 795-8297
(956) 794-8888
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
J7581
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102583501
—
TX
Enumeration date
02/09/2006
Last updated
09/16/2020
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