Provider Demographics
NPI:1689665382
Name:BERIOS, ANGELIS (MD)
Entity Type:Individual
Prefix:
First Name:ANGELIS
Middle Name:
Last Name:BERIOS
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 1:24540 FM 1314 RD
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-4204
Mailing Address - Country:US
Mailing Address - Phone:281-354-4009
Mailing Address - Fax:281-354-8815
Practice Address - Street 1:24540 FM 1314 RD
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-4204
Practice Address - Country:US
Practice Address - Phone:281-354-4009
Practice Address - Fax:281-354-8815
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QJ87OtherBCBS
TX111840801Medicaid
TX00QJ87OtherBCBS
TXC13398Medicare UPIN