Provider Demographics
NPI:1457333882
Name:UGARTE, JOSE M I (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:UGARTE
Suffix:I
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 1:1311 E GENERAL CAVAZOS BLVD STE L
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-7129
Mailing Address - Country:US
Mailing Address - Phone:361-221-1087
Mailing Address - Fax:361-488-5030
Practice Address - Street 1:1311 E GENERAL CAVAZOS BLVD STE L
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7129
Practice Address - Country:US
Practice Address - Phone:361-221-1087
Practice Address - Fax:361-488-5030
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136466303Medicaid
TX1W2441OtherMEDICARE
TX136466303Medicaid
TX136466311Medicaid