Individual
DR. VICENTE MARIO JUAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1425 SANTA FE, CORPUS CHRISTI, TX 78404-2105
(361) 887-9995
(361) 887-8464
Mailing address
1425 SANTA FE, CORPUS CHRISTI, TX 78404-2105
(361) 887-9995
(361) 887-8464
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
F1691
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008G86
BLUS CROSS BLUE SHIELD
TX
05
—
113988301
—
TX
Enumeration date
02/02/2007
Last updated
09/29/2023
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