Healthcare Provider Details

I. General information

NPI: 1962602888
Provider Name (Legal Business Name): BILLY DON ALEXANDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 MALIBU BLVD
EAGLE PASS TX
78852-3351
US

IV. Provider business mailing address

137 ZAMORA CIRCLE
EAGLE PASS TX
78852
US

V. Phone/Fax

Practice location:
  • Phone: 830-773-8474
  • Fax: 830-773-5683
Mailing address:
  • Phone: 830-773-8474
  • Fax: 830-773-5683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD4009
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberD4009
License Number StateTX

VIII. Authorized Official

Name: MRS. BILLY DON ALEXANDER
Title or Position: OWNER
Credential: MD
Phone: 830-773-8474