Provider Demographics
NPI:1659717510
Name:MEDINA, ALFREDO (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:MEDINA
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 1:1310 S ALFORD ST
Mailing Address - Street 2:STE A
Mailing Address - City:CRANE
Mailing Address - State:TX
Mailing Address - Zip Code:79731-3809
Mailing Address - Country:US
Mailing Address - Phone:432-558-3758
Mailing Address - Fax:432-558-3443
Practice Address - Street 1:1310 S ALFORD ST
Practice Address - Street 2:STE A
Practice Address - City:CRANE
Practice Address - State:TX
Practice Address - Zip Code:79731-3809
Practice Address - Country:US
Practice Address - Phone:432-558-3758
Practice Address - Fax:432-558-3443
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine