Provider Demographics
NPI:1215996491
Name:AZEVEDO, ALAN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JOHN
Last Name:AZEVEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 RALEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-8347
Mailing Address - Country:US
Mailing Address - Phone:530-897-4500
Mailing Address - Fax:530-897-4544
Practice Address - Street 1:131 RALEY BLVD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8347
Practice Address - Country:US
Practice Address - Phone:530-897-4500
Practice Address - Fax:530-897-4544
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32695207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G326950Medicaid
ZZZ52846ZOtherBLUE SHIELD
A45251Medicare UPIN
CA00G326950Medicaid