Provider Demographics
NPI:1124080361
Name:CAVAZOS, MIGUEL A JR (MD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:CAVAZOS
Suffix:JR
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 1:1616 LOGAN
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040
Mailing Address - Country:US
Mailing Address - Phone:956-722-5162
Mailing Address - Fax:956-722-0676
Practice Address - Street 1:1616 LOGAN
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040
Practice Address - Country:US
Practice Address - Phone:956-722-5162
Practice Address - Fax:956-722-0676
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5267208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX850770OtherBLUE CROSS BLUE SHIELD
TX0087MNOtherBLUE CROSS BLUE SHIELD
TX0087MNOtherBLUE CROSS BLUE SHIELD