Provider Demographics
NPI:1578928099
Name:ALAMO DIVERSE MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:ALAMO DIVERSE MEDICAL SERVICES PLLC
Other - Org Name:DOCTOR A MEDICAL CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTAMIRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-912-1969
Mailing Address - Street 1:8508 SIR LANCELOT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4920
Mailing Address - Country:US
Mailing Address - Phone:210-346-8188
Mailing Address - Fax:
Practice Address - Street 1:8508 SIR LANCELOT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4920
Practice Address - Country:US
Practice Address - Phone:210-346-8188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284196701Medicaid
TXB136383Medicare Oscar/Certification