Provider Demographics
NPI:1639154446
Name:OSORIO-GIRALDO, ALONSO JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALONSO
Middle Name:JAVIER
Last Name:OSORIO-GIRALDO
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 1:250 TREELINE PARK
Mailing Address - Street 2:507
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-7407
Mailing Address - Country:US
Mailing Address - Phone:813-465-9157
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-593-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6325207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1K8330OtherMEDICARE
TXP02593044OtherMCRR
TXQ00010973OtherMCRR
TX284741010Medicaid
TX284741011Medicaid
TX1K8333OtherMEDICARE
TX1K8333OtherMEDICARE