Provider Demographics
NPI:1265483812
Name:PINO, ALFONSO E III (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:E
Last Name:PINO
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 741475
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-1475
Mailing Address - Country:US
Mailing Address - Phone:214-373-9092
Mailing Address - Fax:214-373-9250
Practice Address - Street 1:11910 GREENVILLE AVENUE
Practice Address - Street 2:SUITE 650
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3596
Practice Address - Country:US
Practice Address - Phone:214-373-9092
Practice Address - Fax:214-373-9250
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ4441207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50051739OtherRAILROAD MEDICARE
TX5125471OtherAETNA
TX100346901Medicaid
TX82130FOtherBLUE CROSS BLUE SHIELD TX
TX97384OtherAMERIGROUP
TXG26674Medicare UPIN
TX82130FOtherBLUE CROSS BLUE SHIELD TX