Basic Information
Provider Information
NPI: 1497287189
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YUAN
FirstName: ALEXANDER
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3551 ROGER BROOKE DR
Address2: MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY
City: SAN ANTONIO
State: TX
PostalCode: 782344504
CountryCode: US
TelephoneNumber: 2102925977
FaxNumber: 2109162077
Practice Location
Address1: 3551 ROGER BROOKE DR
Address2: MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY
City: SAN ANTONIO
State: TX
PostalCode: 782344504
CountryCode: US
TelephoneNumber: 2102925077
FaxNumber: 2102927868
Other Information
ProviderEnumerationDate: 03/31/2017
LastUpdateDate: 03/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
208D00000X0102205502VAY Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


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