Provider Demographics
NPI:1225136013
Name:RUNNELS, ALEXANDRA
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:RUNNELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:RUNNELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4499 MEDICAL DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3735
Mailing Address - Country:US
Mailing Address - Phone:210-614-2229
Mailing Address - Fax:210-614-2232
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-614-2229
Practice Address - Fax:210-614-2232
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6610207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158949103Medicaid
TX1589491-04Medicaid
TX8BB442OtherBCBS
8L6987Medicare PIN
H86820Medicare UPIN
TX1589491-04Medicaid