Provider Demographics
NPI:1639175458
Name:GUERRA, JIM J (MD)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:J
Last Name:GUERRA
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 1:1204 KITTERY DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8132
Mailing Address - Country:US
Mailing Address - Phone:512-810-8611
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1204 KITTERY DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8132
Practice Address - Country:US
Practice Address - Phone:512-810-8611
Practice Address - Fax:512-551-2567
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2590207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127007611Medicaid
TX7600029OtherUNITED HEALTHCARE
TX127007610Medicaid
TX8G8840OtherBLUE CROSS BLUE SHIELD
TX127007612Medicaid
TX127007613Medicaid
TX127007614Medicaid
TX9399591007OtherCIGNA
TX156289401Medicaid
TX2543029OtherAETNA
TXBG1920253OtherDEA NUMBER
TX321839YLP2Medicare PIN
TX127007610Medicaid
TX127007613Medicaid
TX156289401Medicaid
TX8L1236Medicare PIN
TXE43730Medicare UPIN
TX8751B0Medicare ID - Type Unspecified
TXTXB160913Medicare PIN