MEDICARE: CARLOS G CIGARROA, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	J1212	TX
2	246W00000X	Cardiology Technician	J1212	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0039HX	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215192364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLOS G CIGARROA, M.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 451428
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-0035
Country	:	US
Telephone Number	:	956-728-8255
Fax Number	:	956-728-0040

Provider Business Practice Location Address
First Line	:	702 E CALTON RD
Second Line	:	SUITE 101
City	:	LAREDO
State	:	TX
Zip	:	78041-3988
Country	:	US
Telephone Number	:	956-728-8255
Fax Number	:	956-728-0400

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CARLOS G CIGARROA
Credential	:	M.D.
Telephone Number	:	956-728-8255

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	07/28/2008

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