Provider Demographics
NPI:1538173414
Name:PULIDO, ALEJANDRO (MD)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:
Last Name:PULIDO
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 1:1901 S 1ST ST
Mailing Address - Street 2:OLIN TEAGUE VA MEDICAL CENTER
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7451
Mailing Address - Country:US
Mailing Address - Phone:254-743-0359
Mailing Address - Fax:
Practice Address - Street 1:1901 SOUTH 1ST STREET
Practice Address - Street 2:OLIN TEAGUE VA MEDICAL CENTER
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-743-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108144207Q00000X, 207QA0505X
IN01065961A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000615203OtherANTHEM BCBS
IL336072282OtherCONTROL SUBSTANCE
IL036108144Medicaid
IN200922910Medicaid
IN200922910Medicaid
IN193810EEMedicare PIN