Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Mauro Provencio, MD

Individual provider Family Medicine Physician · NPI 1952560682

Dr. Mauro Provencio, MD is a Family Practice in El Paso, Texas. Qualified in 2002, 24 years ago. Accepts Medicare assignment. Licensed in Texas.

Years since qualifying
24
Licensed in
TX
In the registry since
2008
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

12810 Edgemere Blvd
El Paso, TX 79938-4532
Phone: (915) 504-6955
Fax: (915) 504-6954
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence P1809 (TX)

Record details

NPI number1952560682
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 6, 2008
Last updated in NPPESFebruary 28, 2024
Certification dateFebruary 28, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Also practisesSPORTS MEDICINE
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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