Provider Demographics
NPI:1336168129
Name:BACA, AMERICO M (MD)
Entity Type:Individual
Prefix:DR
First Name:AMERICO
Middle Name:M
Last Name:BACA
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:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78505-0502
Mailing Address - Country:US
Mailing Address - Phone:956-783-7088
Mailing Address - Fax:956-783-5687
Practice Address - Street 1:722 S NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-2650
Practice Address - Country:US
Practice Address - Phone:956-783-7088
Practice Address - Fax:956-783-5657
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130784504Medicaid
TX00K69GMedicare ID - Type Unspecified