Provider Demographics
NPI:1003005323
Name:QUIROZ, JUAN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:F
Last Name:QUIROZ
Suffix:
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 1:4811A COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1034
Mailing Address - Country:US
Mailing Address - Phone:214-823-5590
Mailing Address - Fax:214-823-6638
Practice Address - Street 1:4811A COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1034
Practice Address - Country:US
Practice Address - Phone:214-823-5590
Practice Address - Fax:214-823-6638
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042816102Medicaid
TX042816102Medicaid