Provider Demographics
NPI:1164492120
Name:AGUILAR, RAUL ALFONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:ALFONSO
Last Name:AGUILAR
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 1:1320 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5524
Mailing Address - Country:US
Mailing Address - Phone:956-381-1347
Mailing Address - Fax:
Practice Address - Street 1:2200 BERGQUIST DRIVE, SUITE 1
Practice Address - Street 2:ATTN: CREDENTIALS OFFICE
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-5300
Practice Address - Country:US
Practice Address - Phone:210-292-6707
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF-6380207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine