Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | Q2506 | TX |
Y | 207Q00000X | Family Doctor | 25739 | OK |
NPI | 1013112044 |
---|---|
Provider Name | Alejandro Anzaldua |
First Address | Oklahoma City, OK 73104-5020 |
Second Address | Oklahoma City, OK 73104-5420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 28/04/2015 |