MEDICARE: MIGUEL A CAVAZOS JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	D5267	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	850770	OTHER	TX	BLUE CROSS BLUE SHIELD
2	0087MN	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1124080361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL A CAVAZOS JR. MD

Provider Business Mailing Address
First Line	:	1616 LOGAN
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78040
Country	:	US
Telephone Number	:	956-722-5162
Fax Number	:	956-722-0676

Provider Business Practice Location Address
First Line	:	1616 LOGAN
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78040
Country	:	US
Telephone Number	:	956-722-5162
Fax Number	:	956-722-0676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/09/2007

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