Provider Demographics
NPI:1972798411
Name:ISKRENKO, ALEXANDER VLADIMIROVICH (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:VLADIMIROVICH
Last Name:ISKRENKO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20602 OSPREY WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-1918
Mailing Address - Country:US
Mailing Address - Phone:405-255-5210
Mailing Address - Fax:
Practice Address - Street 1:3631 BRENNAN BLVD APT 6F
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-1641
Practice Address - Country:US
Practice Address - Phone:405-255-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7285207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist