Provider Demographics
NPI:1821013798
Name:ALAMO, ANTONIO TADEO (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:TADEO
Last Name:ALAMO
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 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:56 N PECOS RD STE A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7332
Practice Address - Country:US
Practice Address - Phone:702-724-8777
Practice Address - Fax:702-724-8749
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36954Medicare ID - Type Unspecified
NVF53682Medicare UPIN