Provider Demographics
NPI:1982675740
Name:MEGO, PEDRO A (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:A
Last Name:MEGO
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 1:1317 ST CLAIRE BLVD STE A5
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6636
Mailing Address - Country:US
Mailing Address - Phone:956-997-6000
Mailing Address - Fax:956-997-6001
Practice Address - Street 1:1317 ST CLAIRE BLVD STE A5
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6636
Practice Address - Country:US
Practice Address - Phone:956-997-6000
Practice Address - Fax:956-997-6001
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1925207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177162802Medicaid
TX177162801Medicaid
TXI40654Medicare UPIN