Provider Demographics
NPI:1487695946
Name:CACERES, ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:CACERES
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:PO BOX 720395
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0395
Mailing Address - Country:US
Mailing Address - Phone:956-686-6860
Mailing Address - Fax:956-686-6864
Practice Address - Street 1:4236 N. MCCOLL
Practice Address - Street 2:SUITE B
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2686
Practice Address - Country:US
Practice Address - Phone:956-686-6860
Practice Address - Fax:956-686-6864
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9990208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044292303Medicaid
TX109700100OtherVALLEY HEALTH PLAN
TX044292306Medicaid
TXG25010Medicare UPIN