Provider Demographics
NPI:1750364659
Name:IRIGOYEN, FRUCTUOSO R (MD)
Entity type:Individual
Prefix:DR
First Name:FRUCTUOSO
Middle Name:R
Last Name:IRIGOYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78505-1599
Mailing Address - Country:US
Mailing Address - Phone:956-627-3738
Mailing Address - Fax:956-627-1465
Practice Address - Street 1:2116 E GRIFFIN PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3295
Practice Address - Country:US
Practice Address - Phone:956-581-0355
Practice Address - Fax:956-581-0363
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG21532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114504701Medicaid
TX114504701Medicaid
00DU98Medicare ID - Type Unspecified