Provider Demographics
NPI:1013111616
Name:CAMACHO, ALVIN CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:CARLOS
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALWIN
Other - Middle Name:CARLOS
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:THE UNIVERSITY OF TEXAS MEDICAL BRANCH
Mailing Address - Street 2:301 UNIVERSITY BLVD
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-0709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0462
Practice Address - Country:US
Practice Address - Phone:409-772-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP3-00258342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
659611419OtherMYUTMB 659611419-COMMERCIAL NUMBER