=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356358915
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAVIER DAVID MARGO JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2006
-----------------------------------------------------
Last Update Date | 06/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 HINOJOSA CIR
-----------------------------------------------------
City | RIO GRANDE CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-735-0881
-----------------------------------------------------
Fax | 956-487-6644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 HINOJOSA CIR
-----------------------------------------------------
City | RIO GRANDE CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78582-4359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-735-0881
-----------------------------------------------------
Fax | 956-487-6644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | L6240
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | L6240
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------