Provider Demographics
NPI:1649401951
Name:EDUARDO GUZMAN MD PA
Entity Type:Organization
Organization Name:EDUARDO GUZMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:956-519-9100
Mailing Address - Street 1:2308 HWY 83 STE F
Mailing Address - Street 2:
Mailing Address - City:PENITAS
Mailing Address - State:TX
Mailing Address - Zip Code:78576-8399
Mailing Address - Country:US
Mailing Address - Phone:956-519-9100
Mailing Address - Fax:956-519-9900
Practice Address - Street 1:2308 HWY 83 STE F
Practice Address - Street 2:
Practice Address - City:PENITAS
Practice Address - State:TX
Practice Address - Zip Code:78576-8399
Practice Address - Country:US
Practice Address - Phone:956-519-9100
Practice Address - Fax:956-519-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2631208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A6000OtherMEDICARE