Provider Demographics
NPI:1154410157
Name:ONOFREI, ALEX JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:JOSEPH
Last Name:ONOFREI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDER
Other - Middle Name:J
Other - Last Name:ONOFREI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6130 E BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4960
Mailing Address - Country:US
Mailing Address - Phone:480-807-3554
Mailing Address - Fax:480-807-8330
Practice Address - Street 1:6130 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4960
Practice Address - Country:US
Practice Address - Phone:480-807-3554
Practice Address - Fax:480-807-8330
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24575207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ106146OtherMEDICARE ID-PIN
AZZ106146OtherMEDICARE ID-PIN
AZG43630Medicare UPIN