Provider Demographics
NPI:1104981315
Name:ALAMO ASTHMA & ALLERGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:ALAMO ASTHMA & ALLERGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:210-499-0033
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291-0156
Mailing Address - Country:US
Mailing Address - Phone:210-499-0033
Mailing Address - Fax:210-404-0926
Practice Address - Street 1:104 GALLERY CIR
Practice Address - Street 2:SUITE 126
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3329
Practice Address - Country:US
Practice Address - Phone:210-499-0033
Practice Address - Fax:210-404-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133677801Medicaid
TX167435001Medicaid
8501B1Medicare ID - Type Unspecified
TX167435001Medicaid