Provider Demographics
NPI:1720230725
Name:FERRUFINO, LUIS EDGARDO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:EDGARDO
Last Name:FERRUFINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:E
Other - Last Name:FERRUFINO-MALTEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3238
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0055
Mailing Address - Country:US
Mailing Address - Phone:956-618-3979
Mailing Address - Fax:956-618-3975
Practice Address - Street 1:833 W DOVE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-618-3979
Practice Address - Fax:956-618-3975
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2011-0625207Q00000X
TXP1996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX295451301Medicaid
TX8DE594OtherBCBS
TX8DE594OtherBCBS