Provider Demographics
NPI:1528039120
Name:RIO GRANDE VALLEY ADULT & INTERNAL MEDICINE SPECIALISTS PA
Entity Type:Organization
Organization Name:RIO GRANDE VALLEY ADULT & INTERNAL MEDICINE SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-968-1621
Mailing Address - Street 1:1010 JAMES ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6654
Mailing Address - Country:US
Mailing Address - Phone:956-968-1621
Mailing Address - Fax:956-447-0646
Practice Address - Street 1:1010 JAMES ST
Practice Address - Street 2:SUITE B
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6654
Practice Address - Country:US
Practice Address - Phone:956-968-1621
Practice Address - Fax:956-447-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155526001Medicaid
TXG13959Medicare UPIN
TX155526001Medicaid