Provider Demographics
NPI:1013173798
Name:JUAN M. PADILLA, MD,FASC,PA
Entity Type:Organization
Organization Name:JUAN M. PADILLA, MD,FASC,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-687-1998
Mailing Address - Street 1:1200 E SAVANNAH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1727
Mailing Address - Country:US
Mailing Address - Phone:956-687-1998
Mailing Address - Fax:956-630-1078
Practice Address - Street 1:1200 EAST SAVANNAH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503
Practice Address - Country:US
Practice Address - Phone:956-687-1998
Practice Address - Fax:956-630-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8896207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z930Medicare PIN