Provider Demographics
NPI:1770680373
Name:MIRELES, RAUL (MD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:MIRELES
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:PO BOX 450051
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0051
Mailing Address - Country:US
Mailing Address - Phone:956-722-5221
Mailing Address - Fax:956-717-2910
Practice Address - Street 1:7210 MCPHERSON RD
Practice Address - Street 2:STE 210A
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6507
Practice Address - Country:US
Practice Address - Phone:956-722-5221
Practice Address - Fax:956-717-2910
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8075208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH0037511OtherDPS
TX152853101Medicaid
TX152853101Medicaid
TXAM8750273OtherDEA
TX152853101Medicaid