Provider Demographics
NPI:1033506019
Name:SPLINTER, ALICE RENEE (MD)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:RENEE
Last Name:SPLINTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:RENEE
Other - Last Name:HUBBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-9003
Mailing Address - Country:US
Mailing Address - Phone:903-676-3200
Mailing Address - Fax:903-676-3277
Practice Address - Street 1:117 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-9003
Practice Address - Country:US
Practice Address - Phone:903-676-3200
Practice Address - Fax:903-676-3277
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6109208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX387130301Medicaid