Provider Demographics
NPI:1518965789
Name:AGUIRRE-BURGOS, JESUS I (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:I
Last Name:AGUIRRE-BURGOS
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 1:7210 MCPHERSON RD STE 220
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6505
Mailing Address - Country:US
Mailing Address - Phone:956-796-4990
Mailing Address - Fax:956-796-4992
Practice Address - Street 1:7210 MCPHERSON RD STE 220
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6505
Practice Address - Country:US
Practice Address - Phone:956-796-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6206208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139624420Medicaid
TX139624421Medicaid
TX139624421Medicaid
TX139624420Medicaid
TXTXB124608Medicare PIN