Provider Demographics
NPI:1326481664
Name:PASCUAL, JUANCARLO S (MD)
Entity Type:Individual
Prefix:DR
First Name:JUANCARLO
Middle Name:S
Last Name:PASCUAL
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 1:604 ST. MICHAEL DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503
Mailing Address - Country:US
Mailing Address - Phone:903-614-5110
Mailing Address - Fax:903-614-5114
Practice Address - Street 1:604 ST. MICHAEL DR
Practice Address - Street 2:SUITE 340
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-614-5110
Practice Address - Fax:903-614-5114
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0926207Q00000X
LA304225207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program