Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | P1646 | TX |
N | 207RG0300X | Geriatric Medicine | P1646 | TX |
NPI | 1154568558 |
---|---|
Provider Name | Eduardo Miguel Guerra Valencia |
First Address | Mcallen, TX 78503 |
Second Address | Mcallen, TX 78503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2009 |
Last Update Date | 20/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
296889302 | (05) | TX |