Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | E3752 | TX |
NPI | 1073573002 |
---|---|
Provider Name | Dr. Alfonso M Prado |
First Address | Corpus Christi, TX 78414-2931 |
Second Address | Corpus Christi, TX 78414-2429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 18/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115994902 | (05) | TX |
741988939 | TAX IDENTIFICATION NUMBER (01) | TX |
E80283 | (02) | TX |