Provider Demographics
NPI:1376564153
Name:GUAJARDO, ARTURO (MD)
Entity Type:Individual
Prefix:
First Name:ARTURO
Middle Name:
Last Name:GUAJARDO
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 1:3800 S WS YOUNG
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-3312
Mailing Address - Country:US
Mailing Address - Phone:254-415-7698
Mailing Address - Fax:254-415-7689
Practice Address - Street 1:130 FISHER RD UNIT 1
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-8132
Practice Address - Country:US
Practice Address - Phone:802-225-7103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8066207Q00000X
VT042-0015003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B8800Medicare ID - Type Unspecified
TX166556401Medicare ID - Type Unspecified
TXI06365Medicare UPIN