Provider Demographics
NPI:1609022847
Name:ALTAMIRANO, RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:
Last Name:ALTAMIRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1342
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-1342
Mailing Address - Country:US
Mailing Address - Phone:210-912-1969
Mailing Address - Fax:210-966-1057
Practice Address - Street 1:2619 SE MILITARY DR
Practice Address - Street 2:STE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-4312
Practice Address - Country:US
Practice Address - Phone:210-704-1777
Practice Address - Fax:210-333-0775
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0535261QU0200X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284196701Medicaid
TXTXB136383Medicare Oscar/Certification