Provider Demographics
NPI:1245212646
Name:VARELA, HUMBERTO J (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:J
Last Name:VARELA
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 1:506 GALE STREET
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:956-727-8760
Mailing Address - Fax:956-727-0504
Practice Address - Street 1:506 GALE ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6003
Practice Address - Country:US
Practice Address - Phone:956-727-8760
Practice Address - Fax:956-727-0504
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-19
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8990207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00LR55OtherBCBS
TX034757701Medicaid
TXLR55Medicare ID - Type Unspecified
TX034757701Medicaid