Provider Demographics
NPI:1982883948
Name:EHSAN, ALEX A (MD,)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:A
Last Name:EHSAN
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:ESANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:2800 HIGHWAY 75 NORTH
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-0504
Practice Address - Country:US
Practice Address - Phone:903-892-9455
Practice Address - Fax:903-892-4910
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6595207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200196880AMedicaid
TX192993701Medicaid
TX8AA599OtherBCBS
TXP00608951OtherRAILROAD MEDICARE
TX8K6900Medicare PIN
OK295810YTAHMedicare PIN
TX295810YTAHMedicare PIN