Provider Demographics
NPI:1346349354
Name:TREVINO, HECTOR RAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:RAUL
Last Name:TREVINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HECTOR
Other - Middle Name:RAUL
Other - Last Name:TREVINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2176 E GARRISON ST
Mailing Address - Street 2:STE. C
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5071
Mailing Address - Country:US
Mailing Address - Phone:830-773-3353
Mailing Address - Fax:830-773-3393
Practice Address - Street 1:2176 E GARRISON ST
Practice Address - Street 2:STE. C
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5071
Practice Address - Country:US
Practice Address - Phone:830-773-3353
Practice Address - Fax:830-773-3393
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159627201Medicaid
TX8A1572Medicare ID - Type Unspecified