Provider Demographics
NPI:1285742247
Name:PELAEZ ANTELO, RAUL ALEJANDRO (M D)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:ALEJANDRO
Last Name:PELAEZ ANTELO
Suffix:
Gender:M
Credentials:M D
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 291286
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-1286
Mailing Address - Country:US
Mailing Address - Phone:830-257-8484
Mailing Address - Fax:830-896-5211
Practice Address - Street 1:2 DAVENTRY LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1239
Practice Address - Country:US
Practice Address - Phone:830-257-8484
Practice Address - Fax:830-896-5211
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH11752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139571718Medicaid
TX8D0839Medicare PIN
8A3009Medicare PIN