Provider Demographics
NPI:1558315036
Name:JAVIER ALONSO, M.D., PH.D., P.A.
Entity Type:Organization
Organization Name:JAVIER ALONSO, M.D., PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:361-991-6611
Mailing Address - Street 1:5242 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4633
Mailing Address - Country:US
Mailing Address - Phone:361-991-6611
Mailing Address - Fax:361-992-6622
Practice Address - Street 1:5242 HOLLY RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4633
Practice Address - Country:US
Practice Address - Phone:361-991-6611
Practice Address - Fax:361-992-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2095208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDG6514OtherMEDICARE RAILROAD
TX148161601Medicaid
TXDG6514OtherMEDICARE RAILROAD
TX148161601Medicaid