Provider Demographics
NPI:1801878525
Name:HESTERBERG, RAYMOND CHESTER JR (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:CHESTER
Last Name:HESTERBERG
Suffix:JR
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 1:1100 FM 802 STE. 103
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521
Mailing Address - Country:US
Mailing Address - Phone:956-542-3930
Mailing Address - Fax:956-542-0933
Practice Address - Street 1:1100 FM 802
Practice Address - Street 2:SUITE 103
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-1504
Practice Address - Country:US
Practice Address - Phone:956-542-3930
Practice Address - Fax:956-542-0933
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099532601Medicaid
TXE40411Medicare UPIN
TX00N31GMedicare ID - Type Unspecified