Healthcare Provider Details

I. General information

NPI: 1598903353
Provider Name (Legal Business Name): ALFONSO H LUEVANO MD P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2009
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 HOSPITAL DR STE B
CARRIZO SPRINGS TX
78834-3835
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 TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberL7622
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberL7622
License Number StateTX

VIII. Authorized Official

Name: DR. ALFONSO H LUEVANO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 830-876-9458