Provider Demographics
NPI:1114378643
Name:JUERGENS, MARIA GRACIELA ZELAYA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GRACIELA ZELAYA
Last Name:JUERGENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:GRACIELA
Other - Last Name:ZELAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3095 KINGSWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4512
Mailing Address - Country:US
Mailing Address - Phone:972-817-1950
Mailing Address - Fax:
Practice Address - Street 1:3095 KINGSWOOD BLVD STE 250
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-4502
Practice Address - Country:US
Practice Address - Phone:972-817-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0131207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine