Provider Demographics
NPI:1124213400
Name:SANTILLAN-GOMEZ, ALFREDO ALEJANDRO (MD, MPH:)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:ALEJANDRO
Last Name:SANTILLAN-GOMEZ
Suffix:
Gender:M
Credentials:MD, MPH:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:5206 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-5251
Practice Address - Country:US
Practice Address - Phone:210-295-5300
Practice Address - Fax:210-614-8740
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8315208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01587661OtherRAILROAD
TX188777003Medicaid
TX206018802OtherCSHCN
TX206018801Medicaid
TX188777003Medicaid
TX206018801Medicaid