Provider Demographics
NPI:1073573002
Name:PRADO, ALFONSO M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:M
Last Name:PRADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALFONSO
Other - Middle Name:M
Other - Last Name:PRADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5913 PATTON
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2931
Mailing Address - Country:US
Mailing Address - Phone:361-653-6361
Mailing Address - Fax:361-653-6371
Practice Address - Street 1:5913 PATTON ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2429
Practice Address - Country:US
Practice Address - Phone:361-653-6361
Practice Address - Fax:361-653-6371
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE37522080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115994902Medicaid
TX741988939OtherTAX IDENTIFICATION NUMBER
TX741988939OtherTAX IDENTIFICATION NUMBER
TX115994902Medicaid