Provider Demographics
NPI:1679526586
Name:JOSE M.LOZANO MD, PA
Entity type:Organization
Organization Name:JOSE M.LOZANO MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-325-9291
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:PREMONT
Mailing Address - State:TX
Mailing Address - Zip Code:78375-0549
Mailing Address - Country:US
Mailing Address - Phone:361-325-9291
Mailing Address - Fax:361-325-9390
Practice Address - Street 1:107 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:FALFURRIAS
Practice Address - State:TX
Practice Address - Zip Code:78355-4301
Practice Address - Country:US
Practice Address - Phone:361-325-9291
Practice Address - Fax:361-325-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085304601Medicaid
TX085304601Medicaid
TX00T54RMedicare ID - Type Unspecified
TXC18579Medicare UPIN
TX00T54RMedicare PIN