Provider Demographics
NPI:1710931159
Name:ALANIS, AUDENCIO (MD)
Entity Type:Individual
Prefix:
First Name:AUDENCIO
Middle Name:
Last Name:ALANIS
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 1:201 ENTERPRISE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3082
Mailing Address - Country:US
Mailing Address - Phone:281-538-1111
Mailing Address - Fax:713-455-4321
Practice Address - Street 1:201 ENTERPRISE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3082
Practice Address - Country:US
Practice Address - Phone:281-538-1111
Practice Address - Fax:713-455-4321
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084785701Medicaid
TX084785701Medicaid
TXB20829Medicare UPIN