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Individual

JESUS D UCOL

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
MD PA

Contact information

Practice address
1718 10TH ST, STE A, WICHITA FALLS, TX 76301-5053
(940) 761-5437
(940) 761-5400
Mailing address
PO BOX 4167, 1718 10TH ST. SUITE A, WICHITA FALLS, TX 76308-0167
(940) 761-5437
(940) 761-5400

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
J9407
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1211948
TX
Enumeration date
08/09/2005
Last updated
07/08/2007
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