Healthcare Provider Details

I. General information

NPI: 1487098133
Provider Name (Legal Business Name): R R JAUERNEK MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 GATEWAY BLVD W SUITE 140
EL PASO TX
79925-7934
US

IV. Provider business mailing address

PO BOX 220122
EL PASO TX
79913-2122
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG1927
License Number StateTX

VIII. Authorized Official

Name: JESUS FERNANDO ESCARZAGA
Title or Position: MANAGER
Credential:
Phone: 915-740-5122