Provider Demographics
NPI:1407075864
Name:XAVIER, AGNES BERTHA (MD)
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:BERTHA
Last Name:XAVIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4805 TRAILS END
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-8036
Mailing Address - Country:US
Mailing Address - Phone:903-784-2951
Mailing Address - Fax:903-739-8084
Practice Address - Street 1:1655 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-2219
Practice Address - Country:US
Practice Address - Phone:903-739-9191
Practice Address - Fax:903-739-2773
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000D61Z8Medicaid
TXP000D61Z8Medicaid