Provider Demographics
NPI:1356077143
Name:ADIRA PHYSICIAN PARTNERS, PLLC
Entity Type:Organization
Organization Name:ADIRA PHYSICIAN PARTNERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-913-5563
Mailing Address - Street 1:10055 TULARE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-7397
Mailing Address - Country:US
Mailing Address - Phone:817-913-5563
Mailing Address - Fax:
Practice Address - Street 1:6999 MCPHERSON RD STE 108
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6450
Practice Address - Country:US
Practice Address - Phone:860-335-6456
Practice Address - Fax:512-582-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty