Provider Demographics
NPI:1306946165
Name:NOLASCO, ALAN E (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:E
Last Name:NOLASCO
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 1:11012 AIRLINE DR SUITE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037
Mailing Address - Country:US
Mailing Address - Phone:281-820-8955
Mailing Address - Fax:281-667-3275
Practice Address - Street 1:11012 AIRLINE DR STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-1112
Practice Address - Country:US
Practice Address - Phone:281-477-7144
Practice Address - Fax:281-667-3275
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152789703Medicaid
TX8V6030OtherBCBS INDIVIDUAL
TX152789702Medicaid
TX152789703Medicaid
TXH39444Medicare UPIN
TX8B4015Medicare PIN