Provider Demographics
NPI:1780776963
Name:VENEGAS, LUIS R (DPM PA)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:R
Last Name:VENEGAS
Suffix:
Gender:M
Credentials:DPM PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5493 RUSTIC MANOR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3920
Mailing Address - Country:US
Mailing Address - Phone:956-574-9733
Mailing Address - Fax:956-574-9730
Practice Address - Street 1:40 MARSELLA BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3579
Practice Address - Country:US
Practice Address - Phone:956-574-9733
Practice Address - Fax:956-574-9730
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPO1452213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7317044OtherAETNA
TX480032167OtherMEDICARE RAILROAD
TX018590201Medicaid
TX7571063OtherCIGNA
TX00457EOtherBLUE CROSS AND BLUE SHIELD OF TEXAS
TX00457EMedicare PIN
TX00457EOtherBLUE CROSS AND BLUE SHIELD OF TEXAS