Provider Demographics
NPI:1205015344
Name:EL PASO INTERNAL MEDICINE
Entity Type:Organization
Organization Name:EL PASO INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LEVESQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-542-0800
Mailing Address - Street 1:1250 E CLIFF DR
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4850
Mailing Address - Country:US
Mailing Address - Phone:915-542-0800
Mailing Address - Fax:
Practice Address - Street 1:1250 E CLIFF DR
Practice Address - Street 2:SUITE 5A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4850
Practice Address - Country:US
Practice Address - Phone:915-542-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty