Provider Demographics
NPI:1598765091
Name:ALDAPE, ADOLFO ALEJANDRO (MDPA)
Entity Type:Individual
Prefix:DR
First Name:ADOLFO
Middle Name:ALEJANDRO
Last Name:ALDAPE
Suffix:
Gender:M
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 E SAUNDERS
Mailing Address - Street 2:B660
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6884
Mailing Address - Country:US
Mailing Address - Phone:956-795-8265
Mailing Address - Fax:956-795-8268
Practice Address - Street 1:1710 E SAUNDERS
Practice Address - Street 2:B660
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6884
Practice Address - Country:US
Practice Address - Phone:956-795-8265
Practice Address - Fax:956-795-8268
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9971207P00000X, 207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153446303Medicaid
TX153446303Medicaid