Provider Demographics
NPI:1952339392
Name:TESORIERO, ALBERT GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:GEORGE
Last Name:TESORIERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4230 LBJ FWY
Mailing Address - Street 2:SUITE 520
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5806
Mailing Address - Country:US
Mailing Address - Phone:972-599-1860
Mailing Address - Fax:866-480-6586
Practice Address - Street 1:4230 LBJ FWY
Practice Address - Street 2:SUITE 520
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5806
Practice Address - Country:US
Practice Address - Phone:972-599-1860
Practice Address - Fax:866-480-6586
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG70112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113724202Medicaid
TX300074692OtherRAILROAD MEDICARE
TX180974600OtherUS DEPT OF LABOR PROV ID
TX8J8280OtherBLUE CROSS BLUE SHIELD
LA1593231Medicaid
TX113724202Medicaid
TX0083CBMedicare ID - Type Unspecified