Provider Demographics
NPI:1851617658
Name:CAZARES, GUILLERMO NICOLAS (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:NICOLAS
Last Name:CAZARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GUILLERMO
Other - Middle Name:NICOLAS
Other - Last Name:CAZARES-AVILA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:701 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-4206
Mailing Address - Country:US
Mailing Address - Phone:432-703-5238
Mailing Address - Fax:
Practice Address - Street 1:701 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-4206
Practice Address - Country:US
Practice Address - Phone:432-703-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744R1102X, 390200000X
TXNA207P00000X
TXR6983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No1744R1102XOther Service ProvidersSpecialistResearch Study
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program