Provider Demographics
NPI:1598903353
Name:ALFONSO H LUEVANO MD P A
Entity Type:Organization
Organization Name:ALFONSO H LUEVANO MD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:H
Authorized Official - Last Name:LUEVANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-876-9458
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-6278
Mailing Address - Country:US
Mailing Address - Phone:830-876-9458
Mailing Address - Fax:830-876-2411
Practice Address - Street 1:504 HOSPITAL DR STE B
Practice Address - Street 2:
Practice Address - City:CARRIZO SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78834-3835
Practice Address - Country:US
Practice Address - Phone:830-876-9458
Practice Address - Fax:830-876-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-31
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7622207VX0000X, 208D00000X
261QM1300X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344750001Medicaid