Provider Demographics
NPI:1477519320
Name:JAUERNEK, REINHARD ROY (MD)
Entity Type:Individual
Prefix:
First Name:REINHARD
Middle Name:ROY
Last Name:JAUERNEK
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 9520
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79995-9520
Mailing Address - Country:US
Mailing Address - Phone:915-545-6664
Mailing Address - Fax:915-545-9799
Practice Address - Street 1:4815 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-545-8823
Practice Address - Fax:915-545-9799
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG19272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118322009OtherCSHCN PROGRAM
NMV4205Medicaid
TX118322007Medicaid
TXD66630Medicare UPIN
TX8D5016Medicare ID - Type Unspecified
TX118322007Medicaid
TXP00132794Medicare PIN
TX118322009OtherCSHCN PROGRAM