Healthcare Provider Details

I. General information

NPI: 1588769871
Provider Name (Legal Business Name): ALFREDO AUGUSTO CISNEROS SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S 1ST ST (MEMORIAL DR.) N/A
TEMPLE TX
76504
US

IV. Provider business mailing address

310 N ORCHARD DR N/A
ROSEBUD TX
76570-0517
US

V. Phone/Fax

Practice location:
  • Phone: 254-778-4811
  • Fax: 254-743-0514
Mailing address:
  • Phone: 254-583-2511
  • Fax: 254-583-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE4817
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: