Provider Demographics
NPI:1346205564
Name:ALTER, NEJEMIE (MD)
Entity Type:Individual
Prefix:
First Name:NEJEMIE
Middle Name:
Last Name:ALTER
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:PO BOX 6096
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-6096
Mailing Address - Country:US
Mailing Address - Phone:361-739-7874
Mailing Address - Fax:
Practice Address - Street 1:5 WATERFRONT DR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8956
Practice Address - Country:US
Practice Address - Phone:361-739-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK17712080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104440603Medicaid
TX8F1396Medicare PIN
TX104440603Medicaid