Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MD200497 | LA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 13888 | NV |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | Q1711 | TX |
NPI | 1003018086 |
---|---|
Provider Name | Dr. Mario Joseph Quesada |
First Address | Brownsville, TX 78526-3831 |
Second Address | Brownsville, TX 78526-3831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 07/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1237710 | (05) | LA |