Provider Demographics
NPI:1629065677
Name:PAJARO, OCTAVIO ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:OCTAVIO
Middle Name:ENRIQUE
Last Name:PAJARO
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 1:1101 BATES AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 BATES AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2607
Practice Address - Country:US
Practice Address - Phone:713-798-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78124208G00000X
MN42551208G00000X
AZ43721208G00000X
TX47905208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0620042943OtherRAILROAD MEDICARE
FL46492OtherBLUECROSS/BLUESHIELD
AZ576711Medicaid
FL46492OtherBLUECROSS/BLUESHIELD
FL0620042943OtherRAILROAD MEDICARE
AZ576711Medicaid