Provider Demographics
NPI:1760479729
Name:HIDALGO, RAUL (DPM)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:HIDALGO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19179 BLANCO RD
Mailing Address - Street 2:SUITE 105, BOX 403
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4042
Mailing Address - Country:US
Mailing Address - Phone:210-222-2990
Mailing Address - Fax:210-227-5575
Practice Address - Street 1:526 CAMDEN ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1924
Practice Address - Country:US
Practice Address - Phone:210-222-2990
Practice Address - Fax:210-227-5575
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1599213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180863601Medicaid
TX0028JZOtherBCBS
TX6129600001Medicare NSC
TXU91162Medicare UPIN
TX00632PMedicare PIN