Provider Demographics
NPI:1275746877
Name:ALAMEDA FAMILY PRACTICE ASSOCIATES
Entity Type:Organization
Organization Name:ALAMEDA FAMILY PRACTICE ASSOCIATES
Other - Org Name:FAMILY PRACTICE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-857-2900
Mailing Address - Street 1:3301 S ALAMEDA ST
Mailing Address - Street 2:201
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1882
Mailing Address - Country:US
Mailing Address - Phone:364-857-2900
Mailing Address - Fax:361-857-2607
Practice Address - Street 1:3301 S ALAMEDA ST
Practice Address - Street 2:201
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1882
Practice Address - Country:US
Practice Address - Phone:364-857-2900
Practice Address - Fax:361-857-2607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCJ8045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00GT61OtherBCBS
TX00GT61Medicare ID - Type Unspecified