Provider Demographics
NPI:1942258116
Name:GARCIA CABALLERO MONGE, AGUSTIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:A
Last Name:GARCIA CABALLERO MONGE
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 919313
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-9313
Mailing Address - Country:US
Mailing Address - Phone:855-707-1542
Mailing Address - Fax:337-237-5102
Practice Address - Street 1:52579 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:LA
Practice Address - Zip Code:70443-2231
Practice Address - Country:US
Practice Address - Phone:985-878-9421
Practice Address - Fax:985-878-1306
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52720207RX0202X
LAMD.207740207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52720OtherMEDICAL LICENSE
CAW18762OtherGROUP MEDICARE
CAGR0100430OtherGROUP MEDICAL
CAF69865Medicare UPIN
CA1902846306OtherGROUP NPI
CAW17316Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO