Provider Demographics
NPI:1295713550
Name:BARRERA, CAYETANO E III (MD)
Entity type:Individual
Prefix:
First Name:CAYETANO
Middle Name:E
Last Name:BARRERA
Suffix:III
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 1:606 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4906
Mailing Address - Country:US
Mailing Address - Phone:956-682-4515
Mailing Address - Fax:956-682-4143
Practice Address - Street 1:606 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4906
Practice Address - Country:US
Practice Address - Phone:956-682-4515
Practice Address - Fax:956-682-4143
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:2006-01-06
Deactivation Code:
Reactivation Date:2007-01-30
Provider Licenses
StateLicense IDTaxonomies
TXD0790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100906001Medicaid
TX100906002Medicaid
B21099Medicare UPIN
TX806592Medicare ID - Type Unspecified
TX891277Medicare ID - Type UnspecifiedVNC