Provider Demographics
NPI:1831189349
Name:TEVENI, PABLO CORTEZ (MD)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:CORTEZ
Last Name:TEVENI
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:PO BOX 1112
Mailing Address - Street 2:
Mailing Address - City:ELECTRA
Mailing Address - State:TX
Mailing Address - Zip Code:76360-1112
Mailing Address - Country:US
Mailing Address - Phone:940-495-3981
Mailing Address - Fax:940-495-4137
Practice Address - Street 1:405 SE ACCESS RD
Practice Address - Street 2:
Practice Address - City:IOWA PARK
Practice Address - State:TX
Practice Address - Zip Code:76367-6985
Practice Address - Country:US
Practice Address - Phone:940-592-3500
Practice Address - Fax:940-592-4820
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136392101Medicaid
TX00H01XOtherBCBS
TX136392101Medicaid