Provider Demographics
NPI:1376516153
Name:CUELLAR, AUGUSTO (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:
Last Name:CUELLAR
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:PO BOX 6193
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-6193
Mailing Address - Country:US
Mailing Address - Phone:430-200-9500
Mailing Address - Fax:903-200-6057
Practice Address - Street 1:3515 ARISTA BLVD
Practice Address - Street 2:# 511
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1196
Practice Address - Country:US
Practice Address - Phone:430-200-9500
Practice Address - Fax:903-200-6057
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9838208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)