Provider Demographics
NPI:1093706889
Name:EGUIA, LUIS E (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:EGUIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4449
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4449
Mailing Address - Country:US
Mailing Address - Phone:956-362-8490
Mailing Address - Fax:956-362-8495
Practice Address - Street 1:1817 S D ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1511
Practice Address - Country:US
Practice Address - Phone:956-362-8490
Practice Address - Fax:956-362-8495
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4358207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155684704Medicaid
TX155684701Medicaid
TX405309YUQGMedicare PIN
TX155684704Medicaid