Provider Demographics
NPI:1780615732
Name:IGOA, JOSE ESTEBAN (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ESTEBAN
Last Name:IGOA
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 1:3716 S J ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1432
Mailing Address - Country:US
Mailing Address - Phone:956-687-5222
Mailing Address - Fax:
Practice Address - Street 1:3600 N 23RD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6144
Practice Address - Country:US
Practice Address - Phone:956-682-4401
Practice Address - Fax:956-664-9081
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG58332084F0202X, 2084P0800X, 2084P0802X, 2084P0805X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128240202Medicaid
TX00G797Medicare ID - Type UnspecifiedMEDICARE
TX128240202Medicaid