Provider Demographics
NPI:1932532199
Name:ALAZAR MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:ALAZAR MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-556-9700
Mailing Address - Street 1:201 WALLS DR
Mailing Address - Street 2:SUITE 505
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4007
Mailing Address - Country:US
Mailing Address - Phone:817-556-9700
Mailing Address - Fax:817-556-9702
Practice Address - Street 1:201 WALLS DR
Practice Address - Street 2:SUITE 505
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4007
Practice Address - Country:US
Practice Address - Phone:817-556-9700
Practice Address - Fax:817-556-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP 4020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty