Provider Demographics
NPI:1881693307
Name:ALTAMIRA, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:ALTAMIRA
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:PO BOX 66545
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6545
Mailing Address - Country:US
Mailing Address - Phone:713-271-9000
Mailing Address - Fax:713-271-8700
Practice Address - Street 1:7789 SOUTHWEST FWY
Practice Address - Street 2:STE. 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1802
Practice Address - Country:US
Practice Address - Phone:713-271-9000
Practice Address - Fax:713-271-8700
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
TXH9750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0053CROtherBC/BS
TXF93583Medicare UPIN
TX00653DMedicare ID - Type Unspecified