Provider Demographics
NPI:1790774321
Name:PINZON, GUILLERMO A (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:A
Last Name:PINZON
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 1:1221 N COTTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3015
Mailing Address - Country:US
Mailing Address - Phone:915-592-7662
Mailing Address - Fax:915-592-8680
Practice Address - Street 1:1221 N COTTON ST STE 100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3015
Practice Address - Country:US
Practice Address - Phone:915-592-7662
Practice Address - Fax:915-592-8680
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX5634207R00000X, 207RE0101X
TXL207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX936296OtherMEDICARE
TX123345405Medicaid
TX00HZ02Medicare PIN