Provider Demographics
NPI:1184821084
Name:AGULLO, FRANCISCO J (MD)
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:J
Last Name:AGULLO
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 1:1387 GEORGE DIETER DR BLDG C301
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7410
Mailing Address - Country:US
Mailing Address - Phone:915-590-7900
Mailing Address - Fax:915-590-7902
Practice Address - Street 1:1387 GEORGE DIETER DR BLDG C301
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7410
Practice Address - Country:US
Practice Address - Phone:915-590-7900
Practice Address - Fax:915-590-7902
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM78132086S0122X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN270085000Medicaid
MN240000326Medicare PIN