Healthcare Provider Details

I. General information

NPI: 1568873651
Provider Name (Legal Business Name): JUAN PABLO DIOCARES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 03/07/2022
Certification Date: 02/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 31ST ST
TEMPLE TX
76508-2710
US

IV. Provider business mailing address

1305 WONDER WORLD DR STE 200
SAN MARCOS TX
78666-7502
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-2111
  • Fax:
Mailing address:
  • Phone: 512-754-8676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberR3313
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: