Individual
DR. JESSE E MEDELLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 BROOKLYN AVE, SUITE #115, SAN ANTONIO, TX 78212-4803
(210) 224-6531
(210) 226-0402
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-2987
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
H8253
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118379002
—
TX
05
—
118379004
—
TX
01
—
5813027
AETNA PPO
TX
01
—
830004821
RAILROAD MEDICARE
TX
01
—
83Z203
BLUECROSS/BLUESHIELD TX.
TX
01
—
924720
AETNA HMO
TX
01
—
P01547660
RAILROAD MEDICARE
TX
Enumeration date
07/25/2006
Last updated
01/15/2019
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