Provider Demographics
NPI:1972779734
Name:ALPHONSO, HELENE M (DO)
Entity Type:Individual
Prefix:
First Name:HELENE
Middle Name:M
Last Name:ALPHONSO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 732973
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2973
Mailing Address - Country:US
Mailing Address - Phone:817-702-8450
Mailing Address - Fax:
Practice Address - Street 1:3200 W EULESS BLVD
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-6253
Practice Address - Country:US
Practice Address - Phone:817-702-3100
Practice Address - Fax:817-920-6271
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM91232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196106201Medicaid
TX8X5116OtherBCBS
TXP00642497OtherRAILROAD MEDICARE
TXP00642497OtherRAILROAD MEDICARE