Healthcare Provider Details

I. General information

NPI: 1871526400
Provider Name (Legal Business Name): ALFONSO LUEVANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S 5TH ST
CARRIZO SPRINGS TX
78834-3802
US

IV. Provider business mailing address

PO BOX 278
CARRIZO SPRINGS TX
78834-6278
US

V. Phone/Fax

Practice location:
  • Phone: 830-876-9458
  • Fax: 830-876-2411
Mailing address:
  • Phone: 830-876-9458
  • Fax: 830-876-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL7622
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: