Healthcare Provider Details

I. General information

NPI: 1992368906
Provider Name (Legal Business Name): LUIS ALBERTO JUAREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S CONROE MEDICAL DR
CONROE TX
77304-4722
US

IV. Provider business mailing address

11511 SHADOW CREEK PKWY
PEARLAND TX
77584-7298
US

V. Phone/Fax

Practice location:
  • Phone: 936-539-4004
  • Fax: 936-521-3964
Mailing address:
  • Phone: 713-442-4997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberT2644
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT2644
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: