Provider Demographics
NPI:1134298219
Name:GUZMAN-GONZALEZ, OCTAVIO E (MD)
Entity Type:Individual
Prefix:
First Name:OCTAVIO
Middle Name:E
Last Name:GUZMAN-GONZALEZ
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 450768
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0018
Mailing Address - Country:US
Mailing Address - Phone:956-717-1775
Mailing Address - Fax:956-717-1725
Practice Address - Street 1:6826 SPRINGFIELD AVE
Practice Address - Street 2:STE 101
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2213
Practice Address - Country:US
Practice Address - Phone:956-717-1775
Practice Address - Fax:956-717-1725
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5338207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0047AAMedicare PIN
TXF69044Medicare UPIN