Provider Demographics
NPI:1033279054
Name:ARTURO GUAJARDO MD PA
Entity Type:Organization
Organization Name:ARTURO GUAJARDO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-415-7598
Mailing Address - Street 1:3800 S WS YOUNG
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-3312
Mailing Address - Country:US
Mailing Address - Phone:254-415-7598
Mailing Address - Fax:254-415-7689
Practice Address - Street 1:3800 S WS YOUNG
Practice Address - Street 2:SUITE 103
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3312
Practice Address - Country:US
Practice Address - Phone:254-415-7598
Practice Address - Fax:254-415-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166549901Medicaid
TX00741WMedicare ID - Type Unspecified
TX166549901Medicaid