Individual
DR. JUAN MANUEL TAVERAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4301 N MESA ST, STE 101, EL PASO, TX 79902-1121
(915) 542-2352
(915) 593-8559
Mailing address
7814 GATEWAY BLVD E, EL PASO, TX 79915-1815
(915) 542-2352
(915) 593-8559
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
J8393
TX
207RC0000X
Cardiovascular Disease Physician
Primary
J8393
TX
207RI0011X
Interventional Cardiology Physician
J8393
TX
207UN0901X
Nuclear Cardiology Physician
J8393
TX
2085B0100X
Body Imaging Physician
J8393
TX
2085R0202X
Diagnostic Radiology Physician
J8393
TX
2085R0204X
Vascular & Interventional Radiology Physician
J8393
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105634302
—
TX
01
—
88T973
BX
TX
Enumeration date
07/22/2005
Last updated
01/21/2022
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