Provider Demographics
NPI:1649277906
Name:GIRALDO, MAURICIO (MD)
Entity type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:
Last Name:GIRALDO
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 1:3110 W MAIN ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4599
Mailing Address - Country:US
Mailing Address - Phone:469-362-8665
Mailing Address - Fax:469-362-8085
Practice Address - Street 1:3110 W MAIN ST
Practice Address - Street 2:SUITE 150
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4599
Practice Address - Country:US
Practice Address - Phone:469-362-8665
Practice Address - Fax:469-362-8085
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175320401Medicaid
TX00505YMedicare PIN
TX8D3797Medicare PIN
TXF93197Medicare UPIN