Individual
MARTIN ALEJANDRO CHACON PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6411 FANNIN ST, HOUSTON, TX 77030-1501
(940) 594-7563
Mailing address
6410 FANNIN ST STE 600, HOUSTON, TX 77030-5206
(940) 594-7563
(713) 512-2242
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
63503
AZ
207R00000X
Internal Medicine Physician
U5366
TX
208M00000X
Hospitalist Physician
Primary
U5366
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R76710
MD/RESIDENT/TEMP LICENSE
AZ
Enumeration date
05/02/2018
Last updated
01/06/2025
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