Provider Demographics
NPI: | 1770565673 |
---|---|
Name: | ALANIS, HERIBERTO JOSE (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | HERIBERTO |
Middle Name: | JOSE |
Last Name: | ALANIS |
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: | 501 ROSE ELLEN BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | MCALLEN |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78501-9045 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 956-994-9894 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 900 S BRYAN RD |
Practice Address - Street 2: | |
Practice Address - City: | MISSION |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78572-6613 |
Practice Address - Country: | US |
Practice Address - Phone: | 956-580-9000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-11-16 |
Last Update Date: | 2019-06-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | J3955 | 207Q00000X, 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 122023801 | Medicaid | |
TX | 122023807 | Medicaid | |
TX | G24547 | Medicare UPIN | |
TX | 8F1325 | Medicare PIN | |
TX | 122023801 | Medicaid | |
TX | 122023807 | Medicaid |