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General NPI Number Information
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NPI Number | 1598775348
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Entity Type | Organization
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Legal Business Name | EL PASO INTEGRATED PHYSICIANS GROUP
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 4532 N MESA ST 2ND FLOOR
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City | EL PASO
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State | TX
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Zip | 79912
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Country | US
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Telephone | 915-544-0326
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Fax | 915-544-2897
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Provider Business Mailing Address
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Address Line | PO BOX 3157
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City | EL PASO
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State | TX
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Zip | 79923-3157
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Country | US
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Telephone | 915-544-0326
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Fax | 915-544-2897
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT A MORENO
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Credential | M.D.
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Telephone | 915-544-0326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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