Provider Demographics
NPI:1225044902
Name:CAVAZOS, JUAN LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:LUIS
Last Name:CAVAZOS
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 1:2150 HIGHWAY 6 S
Mailing Address - Street 2:#100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-4300
Mailing Address - Country:US
Mailing Address - Phone:281-496-4948
Mailing Address - Fax:281-496-1431
Practice Address - Street 1:2150 HIGHWAY 6 S
Practice Address - Street 2:#100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-4300
Practice Address - Country:US
Practice Address - Phone:281-496-4948
Practice Address - Fax:281-496-1431
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9501207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F01609Medicare UPIN
TX8K4361Medicare PIN