Provider Demographics
NPI:1417931031
Name:FIALLO, ALFREDO J (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:J
Last Name:FIALLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7142 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6256
Mailing Address - Country:US
Mailing Address - Phone:210-661-5622
Mailing Address - Fax:210-395-4012
Practice Address - Street 1:400 BALTIMORE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1919
Practice Address - Country:US
Practice Address - Phone:210-228-0743
Practice Address - Fax:210-228-9749
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH6815207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118942503Medicaid
TX390004412OtherMEDICARE RAILROAD
TXE12269Medicare UPIN
TX86G208Medicare PIN