Healthcare Provider Details

I. General information

NPI: 1033514542
Provider Name (Legal Business Name): ALFONSO H LUEVANO MD P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 10/01/2018
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 Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04118
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL7622
License Number StateTX

VIII. Authorized Official

Name: DR. ALFONSO H LUEVANO JR.
Title or Position: DIRECTOR
Credential: MD
Phone: 830-876-9458