Provider Demographics
NPI:1073523866
Name:JUAREZ, MARIO R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:R
Last Name:JUAREZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4151 CALLAGHAN RD
Mailing Address - Street 2:102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-3419
Mailing Address - Country:US
Mailing Address - Phone:210-681-6380
Mailing Address - Fax:210-521-6200
Practice Address - Street 1:4151 CALLAGHAN RD
Practice Address - Street 2:102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-3419
Practice Address - Country:US
Practice Address - Phone:210-681-6380
Practice Address - Fax:210-521-6200
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF-0534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1102709-02Medicaid
TXB2379-2Medicare UPIN
TX1102709-02Medicaid