Provider Demographics
NPI:1831176452
Name:MEGO, AGUSTIN B (MD)
Entity type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:B
Last Name:MEGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 843204
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-3204
Mailing Address - Country:US
Mailing Address - Phone:956-213-5111
Mailing Address - Fax:956-289-5040
Practice Address - Street 1:1102 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9105
Practice Address - Country:US
Practice Address - Phone:956-213-5111
Practice Address - Fax:956-289-5040
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL9808207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1716029-02Medicaid
TX268436YKSJMedicare PIN
TX1716029-02Medicaid