Provider Demographics
NPI:1083154579
Name:RGV FAMILY MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:RGV FAMILY MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:956-541-5231
Mailing Address - Street 1:PO BOX 4119
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-4119
Mailing Address - Country:US
Mailing Address - Phone:956-541-5231
Mailing Address - Fax:956-541-9588
Practice Address - Street 1:7480 PADRE ISLAND HWY
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3449
Practice Address - Country:US
Practice Address - Phone:956-541-5231
Practice Address - Fax:956-541-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T803Medicare UPIN