Healthcare Provider Details

I. General information

NPI: 1659786044
Provider Name (Legal Business Name): WAGNER VAZ GUIMARAES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

IV. Provider business mailing address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

V. Phone/Fax

Practice location:
  • Phone: 956-687-6155
  • Fax: 956-682-0597
Mailing address:
  • Phone: 956-687-6155
  • Fax: 956-682-0597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberS5099
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS5099
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: