Provider Demographics
NPI:1447254784
Name:VENZOR, JOSE III (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:VENZOR
Suffix:III
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 1:11410 VISTA DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5331
Mailing Address - Country:US
Mailing Address - Phone:915-592-6269
Mailing Address - Fax:915-592-8847
Practice Address - Street 1:11410 VISTA DEL SOL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5331
Practice Address - Country:US
Practice Address - Phone:915-592-6269
Practice Address - Fax:915-592-8847
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2022-08-11
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-21
Provider Licenses
StateLicense IDTaxonomies
TXJ2994207KA0200X, 174400000X
NM92-370174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166563001Medicaid
TX113348004Medicaid
TX113348004Medicaid
TX166563001Medicaid
TX00517UMedicare ID - Type Unspecified