Provider Demographics
NPI:1780675892
Name:BANEZ, ALBERTO Q (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:Q
Last Name:BANEZ
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 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TX
Mailing Address - Zip Code:76380-2343
Mailing Address - Country:US
Mailing Address - Phone:940-889-5583
Mailing Address - Fax:940-889-8835
Practice Address - Street 1:201 STADIUM DR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TX
Practice Address - Zip Code:76380-2343
Practice Address - Country:US
Practice Address - Phone:940-889-5583
Practice Address - Fax:940-889-8835
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7694208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBA000H64LOtherBLUE CROSS
TX127972101Medicaid
TXBA000H64LOtherBLUE CROSS
TX020009153OtherRAILROAD MEDICARE PIN
TXBA000H64LOtherBLUE CROSS