Provider Demographics
NPI:1942573407
Name:PABLO CORTEZ TEVENI, MD PA
Entity Type:Organization
Organization Name:PABLO CORTEZ TEVENI, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:CORTEZ
Authorized Official - Last Name:TEVENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-425-7632
Mailing Address - Street 1:2045 J B RILEY RD
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-5754
Mailing Address - Country:US
Mailing Address - Phone:432-425-7632
Mailing Address - Fax:
Practice Address - Street 1:405 SE ACCESS RD
Practice Address - Street 2:
Practice Address - City:IOWA PARK
Practice Address - State:TX
Practice Address - Zip Code:76367-6985
Practice Address - Country:US
Practice Address - Phone:940-592-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00H01XOtherBCBS
TX136392101Medicaid
TX136392101Medicaid