Provider Demographics
NPI:1649261355
Name:ANCHONDO, HOMERO RENE (MD PA)
Entity type:Individual
Prefix:DR
First Name:HOMERO
Middle Name:RENE
Last Name:ANCHONDO
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3607 KINGSTON VALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-5037
Mailing Address - Country:US
Mailing Address - Phone:281-787-2754
Mailing Address - Fax:281-870-1533
Practice Address - Street 1:3607 KINGSTON VALE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-5037
Practice Address - Country:US
Practice Address - Phone:281-787-2754
Practice Address - Fax:281-870-1533
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE7361207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B20906Medicare UPIN
TXCF19Medicare ID - Type Unspecified