Basic Information
Provider Information | |||||||||
NPI: | 1003913617 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALVES | ||||||||
FirstName: | TAHIRA | ||||||||
MiddleName: | PALMER | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PALMER | ||||||||
OtherFirstName: | TAHIRA | ||||||||
OtherMiddleName: | ANYANNA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 7142 SAN PEDRO AVE | ||||||||
Address2: | SUITE 120 | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782166256 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2106615622 | ||||||||
FaxNumber: | 2107986810 | ||||||||
Practice Location | |||||||||
Address1: | 10010 ROGERS CROSSING | ||||||||
Address2: | SUITE 210 | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782513818 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2105493524 | ||||||||
FaxNumber: | 2106929671 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/19/2006 | ||||||||
LastUpdateDate: | 07/07/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/07/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | N3439 | TX | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
ID | Type | State | Issuer | Description | 206694605 | 05 | TX |   | MEDICAID | P01092754 | 01 | TX | MEDICARE RAILROAD | OTHER |