Provider Demographics
NPI:1497963698
Name:VALLARINO, ANTHONY ALEXIS (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ALEXIS
Last Name:VALLARINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 SAM RAYBURN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454
Mailing Address - Country:US
Mailing Address - Phone:469-796-4125
Mailing Address - Fax:469-796-4124
Practice Address - Street 1:3080 SAM RAYBURN HIGHWAY
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454
Practice Address - Country:US
Practice Address - Phone:469-796-4125
Practice Address - Fax:469-796-4124
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204288901Medicaid
TX8L1383Medicare PIN
TXP00642611Medicare PIN