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General NPI Number Information
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NPI Number | 1710048756
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Entity Type | Organization
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Legal Business Name | JHONNY MARTIN BAZAN MD PA
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 10/19/2024
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Provider Practice Location Address
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Address Line | 1337 E PALMA VISTA DR STE A
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City | PALMVIEW
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State | TX
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Zip | 78572-2055
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Country | US
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Telephone | 956-519-9500
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Fax | 956-519-4549
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Provider Business Mailing Address
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Address Line | 1337 E PALMA VISTA DR STE A
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City | PALMVIEW
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State | TX
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Zip | 78572-2055
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Country | US
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Telephone | 956-519-9500
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Fax | 956-514-9414
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Authorized Official
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Title or Position | OWNER MD/ PROVIDER/ PRESIDENT
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Name | JHONNY MARTIN BAZAN
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Credential | MD
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Telephone | 956-519-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | K1355
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | K1355
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License Number State | TX
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Taxonomy #3
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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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