Individual
DR. OCTAVIO LICON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10410 VISTA DEL SOL DR, EL PASO, TX 79925-7919
(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
86-269
NM
207X00000X
Orthopaedic Surgery Physician
Primary
F2773
TX
207XS0106X
Orthopaedic Hand Surgery Physician
86-269
NM
207XS0106X
Orthopaedic Hand Surgery Physician
F2773
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000Y3758
—
NM
05
—
P000EN585
—
TX
Enumeration date
01/12/2006
Last updated
04/06/2010
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