Provider Demographics
NPI:1063424919
Name:ALLES, AJIT J (MBBS, PHD)
Entity type:Individual
Prefix:
First Name:AJIT
Middle Name:J
Last Name:ALLES
Suffix:
Gender:M
Credentials:MBBS, PHD
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 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4289
Practice Address - Fax:682-885-6111
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3970207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107417100OtherFIRSTCARE PIN
TX1184323OtherFIRSTHEALTH PIN
TX122325706Medicaid
TX85110YOtherBCBSTX IND PIN
TX0083EBOtherBCBSTX GRP PIN
TX10019379OtherAMERIGROUP PIN
TX122325707OtherCSHCN
TX1920588OtherUHC PIN
TX5073586OtherAETNA PIN
TX9080102OtherPHCS PIN
TX0072990OtherCIGNA PIN
1750369203OtherGRP NPI NUMBER
TX124026OtherSUPERIOR PIN
TX5073586OtherAETNA PIN
TX85110YOtherBCBSTX IND PIN