Provider Demographics
NPI:1770779506
Name:PANIAGUA, JULIAN ROBERTO (MD)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:ROBERTO
Last Name:PANIAGUA
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 1:6000 NORTHERN PASS DR STE B-2
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-7211
Mailing Address - Country:US
Mailing Address - Phone:915-321-5057
Mailing Address - Fax:915-321-5058
Practice Address - Street 1:6000 NORTHERN PASS DR STE B-2
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-7211
Practice Address - Country:US
Practice Address - Phone:915-321-5057
Practice Address - Fax:915-321-5058
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0740208000000X
TXN0342208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMU2226Medicaid
TX103740001Medicaid