Provider Demographics
NPI:1770626780
Name:ESPARZA, RAY JOSEPH (MD02)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:JOSEPH
Last Name:ESPARZA
Suffix:
Gender:M
Credentials:MD02
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11029 DEEP BROOK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-2444
Mailing Address - Country:US
Mailing Address - Phone:512-219-6967
Mailing Address - Fax:
Practice Address - Street 1:3801 S. LAMAR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7943
Practice Address - Country:US
Practice Address - Phone:512-447-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3938208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15499Medicare UPIN