Provider Demographics
NPI:1578542460
Name:LONGORIA, MARIO ABEL (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ABEL
Last Name:LONGORIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7200 WYOMING SPGS
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4303
Mailing Address - Country:US
Mailing Address - Phone:512-244-0111
Mailing Address - Fax:512-244-2479
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:SUITE 500
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4303
Practice Address - Country:US
Practice Address - Phone:512-244-0111
Practice Address - Fax:512-244-2479
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1887208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CX700OtherBCBS
TX175973005Medicaid
TX175973004Medicaid
TX8CX700OtherBCBS
TXTXB137016Medicare PIN