Provider Demographics
NPI:1295707511
Name:MEDELLIN, HECTOR (MD)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:MEDELLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 KATY FWY
Mailing Address - Street 2:STE. 315
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1342
Mailing Address - Country:US
Mailing Address - Phone:713-547-5786
Mailing Address - Fax:713-467-6881
Practice Address - Street 1:9601 KATY FWY
Practice Address - Street 2:STE. 315
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1342
Practice Address - Country:US
Practice Address - Phone:713-547-5786
Practice Address - Fax:713-467-6881
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
E10950Medicare UPIN