Provider Demographics
NPI:1861637597
Name:SIQUEIROS, ALAN (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:SIQUEIROS
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 1:10007 HUEBNER RD STE 402
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1640
Mailing Address - Country:US
Mailing Address - Phone:210-692-0361
Mailing Address - Fax:210-593-4066
Practice Address - Street 1:10007 HUEBNER RD STE 402
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1640
Practice Address - Country:US
Practice Address - Phone:210-692-0361
Practice Address - Fax:210-593-4066
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8354207RC0200X, 207RP1001X
CT50717207RP1001X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX361928001Medicaid
TX504699ZPSEMedicare PIN