Provider Demographics
NPI:1770763518
Name:PERALTA, ALEXANDER JR (MD)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:PERALTA
Suffix:JR
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 382344
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75138-2344
Mailing Address - Country:US
Mailing Address - Phone:469-955-8191
Mailing Address - Fax:972-296-2114
Practice Address - Street 1:802 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2118
Practice Address - Country:US
Practice Address - Phone:469-955-8191
Practice Address - Fax:972-296-2114
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4680207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC20836Medicare UPIN