1013556059 NPI number — DR. LUIS EDUARDO AGUERREVERE PH.D.

Table of content: DR. LUIS EDUARDO AGUERREVERE PH.D. (NPI 1013556059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013556059 NPI number — DR. LUIS EDUARDO AGUERREVERE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGUERREVERE
Provider First Name:
LUIS
Provider Middle Name:
EDUARDO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AGUERREVERE SUAREZ
Provider Other First Name:
LUIS
Provider Other Middle Name:
EDUARDO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1013556059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1609 W FRANK AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUFKIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75904-3193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-272-0555
Provider Business Mailing Address Fax Number:
936-272-0555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1609 W FRANK AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUFKIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75904-3193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-272-0555
Provider Business Practice Location Address Fax Number:
936-272-0555
Provider Enumeration Date:
12/21/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  38332 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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