Provider Demographics
NPI:1124784327
Name:ALONZO, ROBERT (IDHS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ALONZO
Suffix:
Gender:M
Credentials:IDHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EDIZ HOOK
Mailing Address - Street 2:MEDICAL
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:98362
Mailing Address - Country:US
Mailing Address - Phone:360-417-5894
Mailing Address - Fax:
Practice Address - Street 1:1 EDIZ HOOK
Practice Address - Street 2:MEDICAL
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:98362
Practice Address - Country:US
Practice Address - Phone:360-417-5894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman