MEDICARE: DR. ALFREDO EQUIGUA JR. MD

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	207Q00000X	Family Medicine Physician	V9593	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1700536653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFREDO EQUIGUA JR. MD

Provider Business Mailing Address
First Line	:	208 E OLIVE ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-4910
Country	:	US
Telephone Number	:	956-441-5041
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 LAFAYETTE ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-2461
Country	:	US
Telephone Number	:	956-795-8100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	07/03/2025

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