Provider Demographics
NPI:1871513143
Name:AMADOR, ALCIDES NICOLAS (MD)
Entity Type:Individual
Prefix:MR
First Name:ALCIDES
Middle Name:NICOLAS
Last Name:AMADOR
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 1:1512 E GRIFFIN PKWY #2
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2424
Mailing Address - Country:US
Mailing Address - Phone:956-583-2211
Mailing Address - Fax:956-583-1353
Practice Address - Street 1:1512 E GRIFFIN PARKWAY #2
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2424
Practice Address - Country:US
Practice Address - Phone:956-583-2211
Practice Address - Fax:956-583-1353
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031107801Medicaid
TX031107801Medicaid
F50183Medicare UPIN