Provider Demographics
NPI:1134143225
Name:GUERRA, JOHN ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:GUERRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2477
Mailing Address - Country:US
Mailing Address - Phone:956-686-3900
Mailing Address - Fax:956-686-3323
Practice Address - Street 1:4304 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2477
Practice Address - Country:US
Practice Address - Phone:956-686-3900
Practice Address - Fax:956-686-3323
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7505207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122362004Medicaid
TX122362004Medicaid