Provider Demographics
NPI:1578545901
Name:PAGAN, JOSE E (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:E
Last Name:PAGAN
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 72746
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78472-2746
Mailing Address - Country:US
Mailing Address - Phone:361-993-1640
Mailing Address - Fax:361-985-2065
Practice Address - Street 1:5934 S STAPLES ST
Practice Address - Street 2:SUITE #230
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3842
Practice Address - Country:US
Practice Address - Phone:361-993-1640
Practice Address - Fax:361-985-2065
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK09742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00394GOtherBCBS OF TX
TX85203KMedicare PIN
G23080Medicare UPIN
TX00394GMedicare ID - Type Unspecified