Provider Demographics
NPI:1811284078
Name:PALACIOS MERCHAN, JUAN DIEGO (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:DIEGO
Last Name:PALACIOS MERCHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2646
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-2646
Mailing Address - Country:US
Mailing Address - Phone:956-362-5650
Mailing Address - Fax:956-362-2574
Practice Address - Street 1:2609 MICHAELANGELO DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1417
Practice Address - Country:US
Practice Address - Phone:956-362-5650
Practice Address - Fax:956-362-2574
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122111207R00000X
TXR8173207RE0101X
FLTRN# 15763390200000X
TXR1843207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX361201201Medicaid
TX523407YY3FMedicare PIN