Provider Demographics
NPI:1255309084
Name:ALVARADO, SERGIO JOSE (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:JOSE
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 117614
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-0853
Mailing Address - Country:US
Mailing Address - Phone:210-615-1901
Mailing Address - Fax:210-615-1905
Practice Address - Street 1:3903 WISEMAN BLVD, STE 311
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4422
Practice Address - Country:US
Practice Address - Phone:210-615-1901
Practice Address - Fax:210-615-1905
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6762207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166241304Medicaid
TX166241303Medicaid
TX166241301Medicaid
TX166241303Medicaid
TX8B9084Medicare PIN
TX166241304Medicaid
TX8K6327Medicare PIN