Provider Demographics
NPI:1073501904
Name:CALVO, RAUL NIDUAZA JR (MD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:NIDUAZA
Last Name:CALVO
Suffix:JR
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:PO BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-437-8615
Mailing Address - Fax:325-437-8697
Practice Address - Street 1:1665 ANTILLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606
Practice Address - Country:US
Practice Address - Phone:325-437-8615
Practice Address - Fax:325-437-8697
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114021202Medicaid
TXC14099Medicare UPIN
TX838077Medicare ID - Type Unspecified