Basic Information
| Provider Information | |||||||||
| NPI: | 1548259690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FIGUEROA | ||||||||
| FirstName: | MARIO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 294 SUMMAR DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312658220 | ||||||||
| FaxNumber: | 7312658355 | ||||||||
| Practice Location | |||||||||
| Address1: | 294 SUMMAR DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314231932 | ||||||||
| FaxNumber: | 7314234919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 39906 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3333293 | 05 | TN | MEDICAID | 35071 | 01 | TN | TLC | OTHER | 1348845 | 01 | TN | CIGNA | OTHER | 168579 | 01 | TN | UNISON | OTHER | 4108545 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER |