Provider Demographics
NPI:1053756098
Name:SHESTOPALOV, ALEXANDER V (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:V
Last Name:SHESTOPALOV
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1050 GEMINI ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2706
Mailing Address - Country:US
Mailing Address - Phone:346-800-1380
Mailing Address - Fax:346-800-1388
Practice Address - Street 1:1050 GEMINI ST STE 202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2706
Practice Address - Country:US
Practice Address - Phone:346-800-1380
Practice Address - Fax:346-800-1388
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2023-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXR54722085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty