Provider Demographics
NPI:1982661518
Name:ESPARZA, ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:ESPARZA
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 1:900 W SAM HOUSTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5217
Mailing Address - Country:US
Mailing Address - Phone:956-783-1000
Mailing Address - Fax:956-783-9679
Practice Address - Street 1:900 W SAM HOUSTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5217
Practice Address - Country:US
Practice Address - Phone:956-783-1000
Practice Address - Fax:956-783-9679
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7411208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1398802-14Medicaid
TX89121NMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
TX1398802-14Medicaid