Provider Demographics
NPI:1124056619
Name:TIJERINA, ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:TIJERINA
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 1:811 E AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-7353
Mailing Address - Country:US
Mailing Address - Phone:903-785-0338
Mailing Address - Fax:903-785-5369
Practice Address - Street 1:811 E AUSTIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-7353
Practice Address - Country:US
Practice Address - Phone:903-785-0338
Practice Address - Fax:903-785-5369
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6196208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX879001OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX340008791OtherRAILROAD MEDICARE
TX0004412062OtherAETNA HEALTHCARE
TX105493401Medicaid
TX879001Medicare PIN
TX105493401Medicaid