Individual
DR. JOSE CARLOS INTERIANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
H7434
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00F74B
BLUE CROSS BLUE SHIELD
TX
01
—
10014840
AMERIGROUP CHIP PROGRAM
TX
01
—
10014841
AMERIGROUP MEDICAID
TX
Enumeration date
08/26/2005
Last updated
07/09/2007
Update your record
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