Provider Demographics
NPI:1407902182
Name:LARES, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:LARES
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 1:1010 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6654
Mailing Address - Country:US
Mailing Address - Phone:956-969-8877
Mailing Address - Fax:956-969-8833
Practice Address - Street 1:902 S AIRPORT DR SUITE 4
Practice Address - Street 2:RIO GRANDE VALLEY ADULT & INTERNAL MEDICINE SPECIALISTS
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6654
Practice Address - Country:US
Practice Address - Phone:956-969-8877
Practice Address - Fax:956-969-8833
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine