Provider Demographics
NPI:1679963409
Name:DECLET, JOSE' RAMON II (PA)
Entity type:Individual
Prefix:MR
First Name:JOSE'
Middle Name:RAMON
Last Name:DECLET
Suffix:II
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:JOSE'
Other - Middle Name:RAMON
Other - Last Name:DECLET
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:4250 HWY 202
Mailing Address - Street 2:UTMB
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102
Mailing Address - Country:US
Mailing Address - Phone:361-358-9890
Mailing Address - Fax:361-362-6654
Practice Address - Street 1:4250 HWY 202
Practice Address - Street 2:UTMB/GARZA UNIT
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102
Practice Address - Country:US
Practice Address - Phone:361-358-9890
Practice Address - Fax:361-362-6654
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01526363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA01526OtherTDCJ STATE PRISON