Provider Demographics
NPI:1942362397
Name:TAMEZ, LUIS HUMBERTO (PHYSISIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:HUMBERTO
Last Name:TAMEZ
Suffix:
Gender:F
Credentials:PHYSISIAN ASSISTANT
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Mailing Address - Street 1:2408 TREASURE HILLS CT
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8646
Mailing Address - Country:US
Mailing Address - Phone:956-982-1001
Mailing Address - Fax:956-982-1938
Practice Address - Street 1:3302 BOCA CHICA BLVD STE 109
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4271
Practice Address - Country:US
Practice Address - Phone:956-982-1001
Practice Address - Fax:956-982-1938
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04091363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL0143546OtherDPS REGISTRATION NUMBER
TXPA04091OtherPHYSICIAN ASSISTANT PERMI