Individual
DR. IRMA MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11335 SSG SIMS, FT BLISS, TX 79918
(915) 742-2273
Mailing address
11335 SSG SIMS, FT BLISS, TX 79918
(915) 742-2273
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
L0867
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101871501
—
TX
01
—
89613X
BC/BS OF TEXAS
TX
Enumeration date
08/23/2006
Last updated
11/13/2023
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