Provider Demographics
NPI:1114903390
Name:LONGORIA, ABEL R (MD)
Entity Type:Individual
Prefix:
First Name:ABEL
Middle Name:R
Last Name:LONGORIA
Suffix:
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 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:301 MEDIC LN
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-5542
Practice Address - Country:US
Practice Address - Phone:281-331-6141
Practice Address - Fax:281-331-3316
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6108207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113688904Medicaid
TX113688905Medicaid
TX1114903390OtherTRICARE SOUTH
TX8Z0618OtherBCBSTX PROV NO
TX113688905Medicaid
TX113688904Medicaid
TX930119699Medicare PIN
TX8927B7Medicare PIN
TXG76809Medicare UPIN
8927B70Medicare PIN