Organization
OCTAVIO LICON, M.D. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OCTAVIO LICON M.D. (PRESIDENT)
(915) 592-3323
Entity
Organization
Contact information
Practice address
10410 VISTA DEL SOL DR., EL PASO, TX 79925
(915) 592-3323
(915) 593-8571
Mailing address
10410 VISTA DEL SOL DR, EL PASO, TX 79925-7919
(915) 592-3323
(915) 593-8571
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
F2773
TX
Other
Enumeration date
06/03/2010
Last updated
06/03/2010
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