Provider Demographics
NPI:1972580967
Name:TRAKHTENBROIT, ANATOLE D (MD)
Entity type:Individual
Prefix:
First Name:ANATOLE
Middle Name:D
Last Name:TRAKHTENBROIT
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 1:8300 FLOYD CURL DR FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3931
Mailing Address - Country:US
Mailing Address - Phone:210-450-4888
Mailing Address - Fax:210-450-6018
Practice Address - Street 1:8300 FLOYD CURL DR FL 3
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3931
Practice Address - Country:US
Practice Address - Phone:210-450-4888
Practice Address - Fax:210-450-6018
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8992207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131700009Medicaid
TX131700012Medicaid
TX131700013OtherCSHCN
TXTXB112453OtherMEDICARE
TX8CM523OtherBCBS
TXP00898298OtherRAILROAD MEDICARE
TXTXB112453Medicare PIN
TX1317000005Medicaid