Provider Demographics
NPI:1568444768
Name:UGARTE, ADRIAN O (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:O
Last Name:UGARTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9963A ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927-2963
Mailing Address - Country:US
Mailing Address - Phone:915-872-0477
Mailing Address - Fax:915-872-0484
Practice Address - Street 1:9963A ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927-2963
Practice Address - Country:US
Practice Address - Phone:915-872-0477
Practice Address - Fax:915-872-0484
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ6784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127013405Medicaid
TX127013402Medicaid
TXG08733Medicare UPIN