Basic Information
Provider Information | |||||||||
NPI: | 1700014909 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALAVEKIOS | ||||||||
FirstName: | DAMON | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2535 W OAK ST | ||||||||
Address2: |   | ||||||||
City: | DENTON | ||||||||
State: | TX | ||||||||
PostalCode: | 762012331 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9403821577 | ||||||||
FaxNumber: | 9403875471 | ||||||||
Practice Location | |||||||||
Address1: | 2535 W OAK ST | ||||||||
Address2: |   | ||||||||
City: | DENTON | ||||||||
State: | TX | ||||||||
PostalCode: | 762012331 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9403821577 | ||||||||
FaxNumber: | 9403875471 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/25/2009 | ||||||||
LastUpdateDate: | 01/28/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/28/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 60523493 | WA | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207X00000X | 39711 | MT | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207X00000X | A115287 | CA | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207X00000X | S0607 | TX | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
No ID Information.