Provider Demographics
NPI:1477516060
Name:ALTON R. PRIHODA, M.D., P.A.
Entity Type:Organization
Organization Name:ALTON R. PRIHODA, M.D., P.A.
Other - Org Name:ONE CHILD PLACE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRIHODA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-427-5223
Mailing Address - Street 1:4201 GARTH RD
Mailing Address - Street 2:SUITE #318
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3167
Mailing Address - Country:US
Mailing Address - Phone:281-427-5223
Mailing Address - Fax:281-422-3873
Practice Address - Street 1:4201 GARTH RD
Practice Address - Street 2:SUITE #318
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3167
Practice Address - Country:US
Practice Address - Phone:281-427-5223
Practice Address - Fax:281-422-3873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9976208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40046577OtherTEXAS DPS PERMIT
TX128544OtherAAP ID NUMBER
TXF9976OtherPHYSICIAN PERMIT NUMBER
TXAP1410973OtherDEA NUMBER
TXC20699Medicare UPIN