Provider Demographics
NPI:1982637286
Name:EDUARDO A PEGUERO MD PA
Entity Type:Organization
Organization Name:EDUARDO A PEGUERO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEGUERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-968-9333
Mailing Address - Street 1:1315 E 6TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4200
Mailing Address - Country:US
Mailing Address - Phone:956-968-9333
Mailing Address - Fax:956-973-0491
Practice Address - Street 1:1315 E 6TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4200
Practice Address - Country:US
Practice Address - Phone:956-968-9333
Practice Address - Fax:956-973-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174575401Medicaid
TX0011MUOtherBCBS
TX00018ZMedicare PIN
TX0011MUOtherBCBS