Provider Demographics
NPI:1215007224
Name:FAZ, CESAR H (MD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:H
Last Name:FAZ
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 1:109 W MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-5501
Mailing Address - Country:US
Mailing Address - Phone:830-778-5439
Mailing Address - Fax:830-778-5400
Practice Address - Street 1:109 W MARTIN ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-5501
Practice Address - Country:US
Practice Address - Phone:830-778-5439
Practice Address - Fax:830-778-5400
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9038208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166733902Medicaid
TX166733901Medicaid
TX8P6044OtherBCBS
TX20-1317705OtherEIN
TX166733902Medicaid