Healthcare Provider Details

I. General information

NPI: 1356077143
Provider Name (Legal Business Name): ADIRA PHYSICIAN PARTNERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6999 MCPHERSON RD STE 108
LAREDO TX
78041-6450
US

IV. Provider business mailing address

10055 TULARE LN
FORT WORTH TX
76177-7397
US

V. Phone/Fax

Practice location:
  • Phone: 860-335-6456
  • Fax: 512-582-8585
Mailing address:
  • Phone: 817-913-5563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR BURGOS
Title or Position: OWNER
Credential: DO
Phone: 817-913-5563