MEDICARE: THEODORE J DISQUE FNP

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	163WC0200X	Critical Care Medicine Registered Nurse	684611	TX
2	363LF0000X	Family Nurse Practitioner	684611	TX

General Provider Information

NPI Number	:	1841930088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE J DISQUE FNP

Provider Business Mailing Address
First Line	:	900 S FLAG ST
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-4424
Country	:	US
Telephone Number	:	956-607-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 S FLAG ST
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-4424
Country	:	US
Telephone Number	:	956-607-3300
Fax Number	:

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

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	03/17/2026

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