Provider Demographics
NPI:1851595359
Name:FIGUEROA, IVAN (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:FIGUEROA
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 3581
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9581
Mailing Address - Country:US
Mailing Address - Phone:214-699-9221
Mailing Address - Fax:972-559-1871
Practice Address - Street 1:14902 PRESTON RD
Practice Address - Street 2:STE 404-1051
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-6801
Practice Address - Country:US
Practice Address - Phone:214-699-9221
Practice Address - Fax:972-559-1871
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6614208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP10017722OtherINSTITUTIONAL PERMIT
BP10017722OtherINSTITUTIONAL PERMIT